- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,344.23 / $4,897.79
| Facility | | $912.01 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,125.38 / $19,054.61
| Facility | | $6,456.54 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $851.14 / $954.99
| Facility | | $812.83 | $851.14 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $1,778.28
| Facility | | $870.96 | $1,258.93 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | 22 | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- 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 |