- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,691.53 / $6,456.54
| Facility | | $1,148.15 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,398.83 / $6,309.57
| Facility | | $1,122.02 | $2,398.83 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $524.81 / $1,905.46
| Facility | | $501.19 | $524.81 | $1,905.46 |
- 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
- $5,370.32 / $10,232.93 / $10,232.93
| Facility | | $5,370.32 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | AS | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,454.71 / $4,677.35
| Facility | | $1,023.29 | $2,454.71 | $4,677.35 |