- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,388.44 / $8,511.38
| Facility | | $1,659.59 | $3,388.44 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,715.19 / $11,220.18
| Facility | | $5,888.44 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,949.84 / $2,511.89
| Facility | | $1,380.38 | $1,949.84 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $2,691.53 / $2,691.53
| Facility | | $34.67 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | 22 | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | AS | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $6,760.83 / $15,488.17
| Facility | | $1,174.90 | $6,760.83 | $15,488.17 |