- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $6,456.54 / $12,589.25
| Facility | | $1,348.96 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $35,481.34
| Facility | | $489.78 | $575.44 | $35,481.34 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,513.56
| Professional | | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,318.26 / $2,089.30
| Facility | | $1,000.00 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,819.70 / $6,309.57
| Facility | | $309.03 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,232.93 / $10,232.93
| Facility | | $5,370.32 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | AS | $1,023.29 | $1,023.29 | $1,023.29 |