- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,165.95 / $15,848.93
| Facility | | $1,584.89 | $6,165.95 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,715.19 / $20,892.96
| Facility | | $3,548.13 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,090.30 / $7,244.36
| Facility | | $1,148.15 | $3,090.30 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 22 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Facility | AS | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,456.54 / $15,848.93
| Facility | | $1,778.28 | $6,456.54 | $15,848.93 |