- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,818.38 / $10,471.29
| Facility | | $1,122.02 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,715.19 / $11,220.18
| Facility | | $7,244.36 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,659.59 / $2,187.76
| Facility | | $1,202.26 | $1,659.59 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $2,290.87 / $2,290.87
| Facility | | $34.67 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | 22 | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $229.09 / $229.09 / $229.09
| Facility | AS | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $10,000.00
| Facility | | $851.14 | $4,677.35 | $10,000.00 |