- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $8,709.64 / $21,877.62
| Facility | | $2,570.40 | $8,709.64 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $35,481.34
| Facility | | $489.78 | $575.44 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 22 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | AS | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Professional | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,137.96 / $3,467.37
| Facility | | $1,621.81 | $2,137.96 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $8,709.64 / $19,952.62
| Facility | | $1,737.80 | $8,709.64 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $23,442.29 / $23,442.29
| Facility | | $8,511.38 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | AS | $2,344.23 | $2,344.23 | $2,344.23 |