- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $11,481.54 / $27,542.29
| Facility | | $1,258.93 | $11,481.54 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $19,498.45 / $45,708.82
| Facility | | $4,168.69 | $19,498.45 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $14,791.08 / $15,488.17
| Facility | | $3,019.95 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | 22 | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | AS | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,949.84
| Professional | | $1,288.25 | $1,288.25 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,096.48 / $1,905.46
| Facility | | $812.83 | $1,096.48 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $22,387.21 / $46,773.51
| Facility | | $8,317.64 | $22,387.21 | $46,773.51 |