- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,466.84 / $10,964.78
| Facility | | $1,412.54 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,912.51 / $16,982.44
| Facility | | $3,162.28 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,398.83 / $5,754.40
| Facility | | $426.58 | $2,398.83 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | 22 | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Facility | AS | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,073.80 / $10,000.00
| Facility | | $1,047.13 | $4,073.80 | $10,000.00 |