- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,388.44 / $9,120.11
| Facility | | $1,096.48 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,709.64 / $12,022.64
| Facility | | $4,466.84 | $8,709.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $3,311.31
| Facility | | $1,000.00 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,819.70 / $4,265.80
| Facility | | $724.44 | $1,819.70 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 22 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Facility | AS | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,677.35 / $11,748.98
| Facility | | $1,096.48 | $4,677.35 | $11,748.98 |