- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,018.63 / $6,577.71 / $22,690.97
| Facility | | $2,018.63 | $6,577.71 | $22,690.97 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $20,597.79 / $20,597.79 / $20,597.79
| Facility | 22 | $20,597.79 | $20,597.79 | $20,597.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,736.52 / $1,736.52 / $1,736.52
| Facility | AS | $1,736.52 | $1,736.52 | $1,736.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,152.50 / $12,802.33 / $25,361.25
| Facility | | $6,152.50 | $12,802.33 | $25,361.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $1,200.00 / $2,151.00
| Facility | | $761.00 | $1,200.00 | $2,151.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.20 / $194.20 / $194.20
| Facility | AS | $194.20 | $194.20 | $194.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.31 / $6,865.50 / $16,475.00
| Facility | | $2,153.31 | $6,865.50 | $16,475.00 |