- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $5,370.32 / $14,791.08
| Facility | | $1,174.90 | $5,370.32 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $23,442.29
| Facility | | $3,548.13 | $10,471.29 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,691.53 / $9,549.93
| Facility | | $1,513.56 | $2,691.53 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | 22 | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | AS | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,120.11 / $20,892.96
| Facility | | $3,019.95 | $9,120.11 | $20,892.96 |