- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,772.37 / $21,379.62
| Facility | | $3,548.13 | $9,772.37 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,623.41 / $13,489.63
| Facility | | $3,981.07 | $5,623.41 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | 22 | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Facility | AS | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,370.32 / $10,471.29
| Facility | | $4,265.80 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,090.30 / $12,022.64
| Facility | | $1,621.81 | $3,090.30 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $7,244.36 / $22,908.68
| Facility | | $1,584.89 | $7,244.36 | $22,908.68 |