- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,495.41 / $15,135.61
| Facility | | $977.24 | $5,495.41 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,905.46 / $6,760.83
| Facility | | $398.11 | $1,905.46 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | 22 | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $20,892.96 / $33,113.11
| Facility | | $9,120.11 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $7,585.78 / $11,748.98
| Facility | | $1,659.59 | $7,585.78 | $11,748.98 |