- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,897.79 / $13,182.57
| Facility | | $1,862.09 | $4,897.79 | $13,182.57 |
- 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 / $7,079.46 / $20,417.38
| Facility | | $323.59 | $7,079.46 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | 22 | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Facility | AS | $436.52 | $436.52 | $436.52 |
- 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 |