- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,248.07 / $12,302.69
| Facility | | $1,412.54 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,912.51 / $16,982.44
| Facility | | $3,311.31 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,511.89 / $8,709.64
| Facility | | $398.11 | $2,511.89 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | 22 | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | AS | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,244.36 / $18,197.01
| Facility | | $2,290.87 | $7,244.36 | $18,197.01 |