- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,495.41 / $11,220.18
| Facility | | $1,318.26 | $5,495.41 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $10,000.00
| Facility | | $34.67 | $398.11 | $10,000.00 |
- 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
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | 62 | $1,584.89 | $1,584.89 | $1,584.89 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $20,892.96 / $33,113.11
| Facility | | $9,120.11 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,128.61 / $10,715.19
| Facility | | $676.08 | $5,128.61 | $10,715.19 |