- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,370.32 / $10,964.78
| Facility | | $1,148.15 | $5,370.32 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $3,548.13
| Facility | | $323.59 | $457.09 | $3,548.13 |
- 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
- $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 |