- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,495.41 / $10,715.19
| Facility | | $1,348.96 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,238.72 / $3,630.78
| Facility | | $1,202.26 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | 22 | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,748.98 / $22,908.68
| Facility | | $5,495.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,585.78 / $11,748.98
| Facility | | $2,290.87 | $7,585.78 | $11,748.98 |