- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,248.07 / $26,302.68
| Facility | | $1,584.89 | $5,248.07 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $13,182.57 / $28,840.32
| Facility | | $4,570.88 | $13,182.57 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,888.44 / $15,135.61
| Facility | | $398.11 | $5,888.44 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | 22 | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | AS | $380.19 | $380.19 | $380.19 |
- 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 |