- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.88 / $5,072.00 / $10,965.00
| Facility | | $1,277.88 | $5,072.00 | $10,965.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $12,803.69 / $12,803.69 / $12,803.69
| Facility | 22 | $12,803.69 | $12,803.69 | $12,803.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.00 / $9,219.00 / $17,206.00
| Facility | | $4,977.00 | $9,219.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.74 / $2,472.40 / $9,277.03
| Facility | | $1,130.74 | $2,472.40 | $9,277.03 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.33 / $112.33 / $112.33
| Facility | AS | $112.33 | $112.33 | $112.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |