- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,466.84 / $10,964.78
| Facility | | $1,513.56 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,120.11 / $17,378.01
| Facility | | $3,388.44 | $9,120.11 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,365.16 / $13,489.63
| Facility | | $398.11 | $4,365.16 | $13,489.63 |
- 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
- $1,513.56 / $4,466.84 / $12,589.25
| Facility | | $1,513.56 | $4,466.84 | $12,589.25 |