- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,570.88 / $10,964.78
| Facility | | $1,584.89 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,882.50 / $25,118.86
| Facility | | $4,365.16 | $12,882.50 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,890.45 / $11,220.18
| Facility | | $549.54 | $3,890.45 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | 22 | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Facility | AS | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,232.93 / $23,988.33
| Facility | | $3,630.78 | $10,232.93 | $23,988.33 |