- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.64 / $5,052.85 / $12,427.00
| Facility | | $1,130.64 | $5,052.85 | $12,427.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $20,796.09 / $20,796.09 / $20,796.09
| Facility | 22 | $20,796.09 | $20,796.09 | $20,796.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,028.80 / $5,028.80 / $5,028.80
| Facility | AS | $5,028.80 | $5,028.80 | $5,028.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,010.00 / $9,877.00 / $17,154.00
| Facility | | $5,010.00 | $9,877.00 | $17,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.94 / $3,209.93 / $4,765.20
| Facility | | $1,518.94 | $3,209.93 | $4,765.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $96.34 / $96.34 / $96.34
| Facility | AS | $96.34 | $96.34 | $96.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |