- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,495.41 / $13,182.57
| Facility | | $1,318.26 | $5,495.41 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,120.11 / $16,982.44
| Facility | | $3,388.44 | $9,120.11 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,584.89 / $6,456.54
| Facility | | $371.54 | $1,584.89 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | 22 | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |