- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $9,772.37 / $18,197.01
| Facility | | $5,888.44 | $9,772.37 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $9,772.37 / $20,417.38
| Facility | | $2,691.53 | $9,772.37 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $15,488.17
| Facility | | $707.95 | $1,096.48 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | 22 | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Facility | AS | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,778.28
| Professional | | $1,380.38 | $1,380.38 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,096.48 / $1,819.70
| Facility | | $758.58 | $1,096.48 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |