- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,888.44 / $15,488.17
| Facility | | $1,584.89 | $5,888.44 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $12,302.69 / $23,988.33
| Facility | | $4,168.69 | $12,302.69 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,890.45 / $13,182.57
| Facility | | $398.11 | $3,890.45 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | 22 | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | AS | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,606.93 / $15,135.61
| Facility | | $2,290.87 | $6,606.93 | $15,135.61 |