- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,471.29 / $25,118.86
| Facility | | $1,995.26 | $10,471.29 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $10,000.00 / $18,197.01
| Facility | | $4,168.69 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $5,754.40
| Facility | | $575.44 | $891.25 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | 22 | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | AS | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,737.80
| Professional | | $1,288.25 | $1,288.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,023.29 / $1,698.24
| Facility | | $741.31 | $1,023.29 | $1,698.24 |
- 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 |