- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,905.46 / $4,466.84
| Facility | | $1,096.48 | $1,905.46 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $15,135.61 / $20,417.38
| Facility | | $12,589.25 | $15,135.61 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | | $2,041.74 | $2,041.74 | $2,041.74 |
- 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
- $3,388.44 / $7,413.10 / $12,589.25
| Facility | | $3,388.44 | $7,413.10 | $12,589.25 |