- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,754.40 / $17,782.79
| Facility | | $1,737.80 | $5,754.40 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $13,803.84 / $30,199.52
| Facility | | $4,897.79 | $13,803.84 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,548.13 / $12,589.25
| Facility | | $645.65 | $3,548.13 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | 22 | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | AS | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $12,022.64 / $30,902.95
| Facility | | $3,630.78 | $12,022.64 | $30,902.95 |