- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $7,413.10 / $18,197.01
| Facility | | $1,584.89 | $7,413.10 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $11,481.54 / $22,387.21
| Facility | | $3,801.89 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,162.28 / $17,782.79
| Facility | | $1,148.15 | $3,162.28 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | 22 | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,595.87
| Facility | | $2,511.89 | $7,244.36 | $16,595.87 |