- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,691.53 / $4,365.16
| Facility | | $933.25 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,754.40 / $8,912.51
| Facility | | $3,162.28 | $5,754.40 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $831.76 / $831.76
| Facility | | $794.33 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $1,479.11
| Facility | | $489.78 | $812.83 | $1,479.11 |
- 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
- $371.54 / $1,174.90 / $5,754.40
| Facility | | $371.54 | $1,174.90 | $5,754.40 |