- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,570.88 / $10,964.78
| Facility | | $776.25 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $3,162.28
| Facility | | $323.59 | $501.19 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,041.74 / $2,041.74 / $2,041.74
| Facility | 22 | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Facility | AS | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $20,892.96 / $33,113.11
| Facility | | $7,943.28 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $5,011.87 / $10,715.19
| Facility | | $616.60 | $5,011.87 | $10,715.19 |