- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,089.30 / $8,317.64
| Facility | | $891.25 | $2,089.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $16,982.44 / $26,302.68
| Facility | | $6,760.83 | $16,982.44 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $3,388.44
| Facility | | $977.24 | $977.24 | $3,388.44 |
- 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
- $549.54 / $707.95 / $1,258.93
| Facility | | $549.54 | $707.95 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $10,715.19 / $26,302.68
| Facility | | $1,023.29 | $10,715.19 | $26,302.68 |