- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.00 / $9,657.46 / $25,267.81
| Facility | | $1,852.00 | $9,657.46 | $25,267.81 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $18,685.91 / $18,685.91 / $18,685.91
| Facility | 22 | $18,685.91 | $18,685.91 | $18,685.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $8,742.00 / $30,357.00
| Facility | | $400.00 | $8,742.00 | $30,357.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,070.46 / $1,070.46 / $1,070.46
| Facility | 62 | $1,070.46 | $1,070.46 | $1,070.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.27 / $171.27 / $171.27
| Facility | AS | $171.27 | $171.27 | $171.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,645.00 / $12,106.00 / $22,833.00
| Facility | | $4,645.00 | $12,106.00 | $22,833.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,595.00 / $12,291.00 / $18,694.00
| Facility | | $3,595.00 | $12,291.00 | $18,694.00 |