- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,897.79 / $14,125.38
| Facility | | $1,258.93 | $4,897.79 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,454.40 / $19,498.45
| Facility | | $6,456.54 | $14,454.40 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,174.90 / $1,318.26
| Facility | | $1,122.02 | $1,174.90 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,584.89 / $2,398.83
| Facility | | $1,174.90 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 22 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Facility | AS | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $7,762.47 / $10,964.78
| Facility | | $1,862.09 | $7,762.47 | $10,964.78 |