- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.65 / $4,521.00 / $12,295.76
| Facility | | $1,196.65 | $4,521.00 | $12,295.76 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $8,662.34 / $8,662.34 / $8,662.34
| Facility | 22 | $8,662.34 | $8,662.34 | $8,662.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $9,270.00 / $20,080.00
| Facility | | $3,248.00 | $9,270.00 | $20,080.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $1,966.73 / $4,175.47
| Facility | | $800.00 | $1,966.73 | $4,175.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.75 / $107.75 / $107.75
| Facility | AS | $107.75 | $107.75 | $107.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $9,914.50 / $21,180.50
| Facility | | $3,340.00 | $9,914.50 | $21,180.50 |