- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,897.79 / $11,748.98
| Facility | | $1,202.26 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,549.93 / $17,782.79
| Facility | | $3,388.44 | $9,549.93 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,659.59 / $5,754.40
| Facility | | $398.11 | $1,659.59 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | 22 | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | AS | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,912.51 / $19,054.61
| Facility | | $2,884.03 | $8,912.51 | $19,054.61 |