- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $11,220.18 / $13,803.84
| Facility | | $1,412.54 | $11,220.18 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $776.25
| Facility | | $630.96 | $630.96 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | 22 | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $9,549.93 / $35,481.34
| Facility | | $6,606.93 | $9,549.93 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $10,000.00
| Facility | | $2,884.03 | $2,884.03 | $10,000.00 |