- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,570.88 / $11,481.54
| Facility | | $1,445.44 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,332.54 / $17,782.79
| Facility | | $3,630.78 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,311.31 / $8,511.38
| Facility | | $398.11 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | 22 | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | AS | $213.80 | $213.80 | $213.80 |
- 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 |