- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,467.37 / $10,964.78
| Facility | | $676.08 | $3,467.37 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $24,547.09 / $31,622.78
| Facility | | $7,413.10 | $24,547.09 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $575.44 / $645.65
| Facility | | $549.54 | $575.44 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,148.15
| Facility | | $562.34 | $794.33 | $1,148.15 |
- 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
- $4,897.79 / $10,964.78 / $17,378.01
| Facility | | $4,897.79 | $10,964.78 | $17,378.01 |