- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.09 / $3,149.40 / $9,009.08
| Facility | | $1,178.09 | $3,149.40 | $9,009.08 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,363.78 / $4,363.78 / $4,363.78
| Facility | 22 | $4,363.78 | $4,363.78 | $4,363.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.52 / $1,107.83 / $2,353.34
| Professional | | $931.52 | $1,107.83 | $2,353.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.96 / $1,313.17 / $1,804.03
| Professional | | $1,006.96 | $1,313.17 | $1,804.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,013.00 / $6,038.00 / $9,283.00
| Facility | | $3,013.00 | $6,038.00 | $9,283.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.00 / $1,405.80 / $2,207.42
| Professional | | $1,027.00 | $1,405.80 | $2,207.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.36 / $1,505.89 / $2,225.98
| Professional | | $1,108.36 | $1,505.89 | $2,225.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,986.80 / $19,913.50 / $26,542.00
| Facility | | $5,986.80 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $272.26 / $1,887.52 / $1,887.52
| Facility | AS | $272.26 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,718.96 / $7,887.28 / $9,162.98
| Professional | | $7,718.96 | $7,887.28 | $9,162.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.20 / $1,255.41 / $2,231.56
| Professional | | $948.20 | $1,255.41 | $2,231.56 |