- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,837.00 / $6,298.62 / $18,600.00
| Facility | | $1,837.00 | $6,298.62 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $23,807.76 / $23,807.76 / $23,807.76
| Facility | 22 | $23,807.76 | $23,807.76 | $23,807.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.43 / $66.43 / $66.43
| Facility | AS | $66.43 | $66.43 | $66.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,499.00 / $25,100.00 / $47,597.80
| Facility | | $11,499.00 | $25,100.00 | $47,597.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,891.01 / $1,891.01 / $7,972.76
| Facility | | $1,891.01 | $1,891.01 | $7,972.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $187.01 / $187.01 / $187.01
| Facility | AS | $187.01 | $187.01 | $187.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,707.00 / $24,484.00
| Facility | | $4,505.00 | $10,707.00 | $24,484.00 |