- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,606.93 / $14,791.08
| Facility | | $5,370.32 | $6,606.93 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,819.70
| Facility | | $1,348.96 | $1,348.96 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | 22 | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | AS | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,606.93 / $14,791.08
| Facility | | $5,370.32 | $6,606.93 | $14,791.08 |