- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $7,244.36 / $23,442.29
| Facility | | $1,230.27 | $7,244.36 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $16,982.44 / $39,810.72
| Facility | | $1,659.59 | $16,982.44 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | 22 | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $11,748.98 / $22,908.68
| Facility | | $5,623.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,302.69 / $34,673.69
| Facility | | $4,677.35 | $12,302.69 | $34,673.69 |