- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,677.35 / $11,481.54
| Facility | | $1,584.89 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $10,715.19 / $20,417.38
| Facility | | $3,467.37 | $10,715.19 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,691.53 / $7,762.47
| Facility | | $323.59 | $2,691.53 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | 22 | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | AS | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |