- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,818.38 / $8,511.38
| Facility | | $851.14 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $10,715.19 / $18,620.87
| Facility | | $9,332.54 | $10,715.19 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,467.37 / $4,168.69
| Facility | | $2,398.83 | $3,467.37 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $4,786.30 / $4,786.30
| Facility | | $34.67 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | 22 | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Facility | AS | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,466.84 / $30,199.52
| Facility | | $602.56 | $4,466.84 | $30,199.52 |