- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $6,760.83 / $14,125.38
| Facility | | $1,230.27 | $6,760.83 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $8,317.64 / $30,199.52
| Facility | | $977.24 | $8,317.64 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | 22 | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Facility | AS | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,748.98 / $22,908.68
| Facility | | $5,495.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,748.98 / $18,620.87
| Facility | | $3,715.35 | $11,748.98 | $18,620.87 |