- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,511.89 / $5,370.32
| Facility | | $891.25 | $2,511.89 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,912.51 / $12,882.50
| Facility | | $4,786.30 | $8,912.51 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $6,760.83 / $6,760.83
| Facility | | $851.14 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,148.15 / $1,584.89
| Facility | | $724.44 | $1,148.15 | $1,584.89 |
- 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
- $1,122.02 / $5,754.40 / $12,882.50
| Facility | | $1,122.02 | $5,754.40 | $12,882.50 |