- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,981.07 / $11,220.18
| Facility | | $831.76 | $3,981.07 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $25,118.86 / $31,622.78
| Facility | | $10,471.29 | $25,118.86 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,621.81 / $1,819.70
| Facility | | $1,548.82 | $1,621.81 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,454.71 / $3,388.44
| Facility | | $1,659.59 | $2,454.71 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | 22 | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Facility | AS | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,623.41 / $12,022.64
| Facility | | $1,023.29 | $5,623.41 | $12,022.64 |