- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $12,882.50 / $28,183.83
| Facility | | $1,096.48 | $12,882.50 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $20,892.96 / $47,863.01
| Facility | | $7,244.36 | $20,892.96 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,365.16 / $10,471.29
| Facility | | $3,090.30 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | 22 | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | AS | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,168.69 / $8,128.31
| Facility | | $3,388.44 | $4,168.69 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $8,317.64 / $19,952.62
| Facility | | $1,862.09 | $8,317.64 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $12,022.64
| Facility | 22 | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,000.00 / $26,915.35
| Facility | | $5,888.44 | $10,000.00 | $26,915.35 |