- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $16,595.87
| Facility | | $2,290.87 | $2,290.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,481.54 / $24,547.09
| Facility | | $5,011.87 | $11,481.54 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,511.38 / $20,417.38
| Facility | | $6,025.60 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | 22 | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Facility | AS | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,128.31 / $15,848.93
| Facility | | $6,606.93 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,630.78 / $6,606.93
| Facility | | $2,290.87 | $3,630.78 | $6,606.93 |
- 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 |