- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,370.32 / $14,125.38
| Facility | | $1,819.70 | $5,370.32 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,232.93 / $20,417.38
| Facility | | $3,630.78 | $10,232.93 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,090.30 / $12,589.25
| Facility | | $398.11 | $3,090.30 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | 22 | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | AS | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,884.03 / $9,772.37
| Facility | | $537.03 | $2,884.03 | $9,772.37 |