- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $5,011.87
| Facility | | $1,047.13 | $1,047.13 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,120.11
| Facility | | $1,862.09 | $4,265.80 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,981.07 / $9,549.93
| Facility | | $2,511.89 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | 22 | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,801.89 / $7,585.78
| Facility | | $3,090.30 | $3,801.89 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,737.80 / $3,467.37
| Facility | | $1,047.13 | $1,737.80 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,265.80 / $10,000.00
| Facility | | $1,096.48 | $4,265.80 | $10,000.00 |