- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,760.83 / $19,952.62
| Facility | | $1,737.80 | $6,760.83 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $11,220.18 / $24,547.09
| Facility | | $4,265.80 | $11,220.18 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,801.89 / $16,595.87
| Facility | | $1,122.02 | $3,801.89 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | 22 | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | AS | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,912.51 / $20,892.96
| Facility | | $3,019.95 | $8,912.51 | $20,892.96 |