- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,677.35 / $11,481.54
| Facility | | $1,778.28 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $11,748.98 / $22,387.21
| Facility | | $4,265.80 | $11,748.98 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,011.87 / $14,125.38
| Facility | | $398.11 | $5,011.87 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | 22 | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Facility | AS | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |