- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,412.54
| Facility | | $1,071.52 | $1,071.52 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,348.96
| Facility | | $1,071.52 | $1,071.52 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,737.80 / $1,737.80
| Facility | | $34.67 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | 22 | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | AS | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |