- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,888.44 / $16,982.44
| Facility | | $1,548.82 | $5,888.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $14,125.38 / $30,199.52
| Facility | | $4,897.79 | $14,125.38 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $4,073.80 / $15,848.93
| Facility | | $645.65 | $4,073.80 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | 22 | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | AS | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,748.98 / $32,359.37
| Facility | | $3,715.35 | $11,748.98 | $32,359.37 |