- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.46 / $2,155.41 / $7,716.17
| Facility | | $342.46 | $2,155.41 | $7,716.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,609.94 / $3,609.94 / $3,609.94
| Facility | 22 | $3,609.94 | $3,609.94 | $3,609.94 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,844.87 / $2,844.87 / $2,844.87
| Facility | 62 | $2,844.87 | $2,844.87 | $2,844.87 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $2,353.44 / $2,353.44 / $2,353.44
| Facility | 80 | $2,353.44 | $2,353.44 | $2,353.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $0.40 / $0.40 / $0.40
| Facility | AS | $0.40 | $0.40 | $0.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.18 / $339.34 / $1,080.00
| Professional | | $230.18 | $339.34 | $1,080.00 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $40.77 / $87.00 / $205.80
| Professional | AS | $40.77 | $87.00 | $205.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $7,007.00 / $14,895.00
| Facility | | $2,629.00 | $7,007.00 | $14,895.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.36 / $347.62 / $525.35
| Professional | | $250.36 | $347.62 | $525.35 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $33.88 / $42.45 / $69.21
| Professional | AS | $33.88 | $42.45 | $69.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.87 / $507.00 / $641.21
| Facility | | $404.87 | $507.00 | $641.21 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $179.42 / $179.42 / $179.42
| Facility | 62 | $179.42 | $179.42 | $179.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $28.71 / $28.71 / $28.71
| Facility | AS | $28.71 | $28.71 | $28.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.31 / $386.29 / $567.95
| Professional | | $265.31 | $386.29 | $567.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,221.00 / $2,791.00
| Facility | | $293.00 | $1,221.00 | $2,791.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.87 / $346.84 / $563.95
| Professional | | $240.87 | $346.84 | $563.95 |