- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,897.79 / $11,748.98
| Facility | | $1,862.09 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,489.63 / $28,183.83
| Facility | | $4,677.35 | $13,489.63 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $6,165.95 / $17,782.79
| Facility | | $323.59 | $6,165.95 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | 22 | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | AS | $380.19 | $380.19 | $380.19 |
- 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 |