- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $7,762.47 / $25,703.96
| Facility | | $1,445.44 | $7,762.47 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $14,791.08 / $23,988.33
| Facility | | $6,606.93 | $14,791.08 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $2,238.72
| Facility | | $1,659.59 | $1,659.59 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | 22 | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $2,089.30
| Facility | | $912.01 | $1,230.27 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $10,964.78 / $23,442.29
| Facility | | $1,659.59 | $10,964.78 | $23,442.29 |