- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $12,882.50 / $30,902.95
| Facility | | $7,244.36 | $12,882.50 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $10,964.78
| Facility | | $3,235.94 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Facility | 22 | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Facility | AS | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,365.16 / $8,511.38
| Facility | | $3,548.13 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,511.89 / $3,981.07
| Facility | | $1,737.80 | $2,511.89 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |