- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,466.84 / $12,022.64
| Facility | | $1,621.81 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,302.69 / $27,542.29
| Facility | | $4,677.35 | $12,302.69 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,677.35 / $14,454.40
| Facility | | $398.11 | $4,677.35 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | 22 | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Facility | AS | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,317.64 / $17,782.79
| Facility | | $2,951.21 | $8,317.64 | $17,782.79 |