- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $5,888.44 / $10,232.93
| Facility | | $954.99 | $5,888.44 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $11,481.54 / $26,302.68
| Facility | | $4,168.69 | $11,481.54 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,570.40 / $6,025.60
| Facility | | $1,819.70 | $2,570.40 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | 22 | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.23 / $120.23 / $120.23
| Facility | AS | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,454.71 / $4,786.30
| Facility | | $1,949.84 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,128.61 / $10,715.19
| Facility | | $1,047.13 | $5,128.61 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,000.00 / $15,135.61
| Facility | | $5,888.44 | $10,000.00 | $15,135.61 |