- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,570.88 / $11,220.18
| Facility | | $1,412.54 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,511.38 / $17,782.79
| Facility | | $3,311.31 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,388.44 / $8,912.51
| Facility | | $398.11 | $3,388.44 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | 22 | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.87 / $223.87 / $223.87
| Facility | AS | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |