- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $6,165.95 / $13,182.57
| Facility | | $660.69 | $6,165.95 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,128.61 / $12,022.64
| Facility | | $2,511.89 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $660.69 / $3,715.35
| Facility | | $34.67 | $660.69 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | 22 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.07 / $66.07 / $66.07
| Facility | AS | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,760.83 / $16,218.10
| Facility | | $1,778.28 | $6,760.83 | $16,218.10 |