- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,630.27 / $8,511.38
| Facility | | $933.25 | $2,630.27 | $8,511.38 |
- 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
- $831.76 / $1,023.29 / $1,445.44
| Facility | | $831.76 | $1,023.29 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,659.59 / $1,659.59
| Facility | | $34.67 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | 22 | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,801.89 / $19,498.45
| Facility | | $1,000.00 | $3,801.89 | $19,498.45 |