- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $7,943.28 / $25,118.86
| Facility | | $1,479.11 | $7,943.28 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,905.46 / $7,079.46
| Facility | | $398.11 | $1,905.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | 22 | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $20,417.38 / $33,113.11
| Facility | | $7,943.28 | $20,417.38 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,220.18 / $18,620.87
| Facility | | $3,715.35 | $11,220.18 | $18,620.87 |