- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,000.00 / $18,197.01
| Facility | | $3,981.07 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $9,332.54 / $17,782.79
| Facility | | $1,737.80 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $2,570.40
| Facility | | $891.25 | $891.25 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | 22 | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | 62 | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | AS | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $3,467.37
| Professional | | $2,398.83 | $2,398.83 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,995.26 / $3,715.35
| Facility | | $1,479.11 | $1,995.26 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |