- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.64 / $6,425.76 / $19,422.15
| Facility | | $1,388.64 | $6,425.76 | $19,422.15 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $6,524.00 / $6,524.00 / $6,524.00
| Facility | 22 | $6,524.00 | $6,524.00 | $6,524.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,524.50 / $12,012.00 / $25,151.76
| Facility | | $5,524.50 | $12,012.00 | $25,151.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $1,000.00 / $2,269.00
| Facility | | $761.00 | $1,000.00 | $2,269.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.14 / $123.14 / $123.14
| Facility | AS | $123.14 | $123.14 | $123.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,011.00 / $7,923.50 / $17,376.00
| Facility | | $2,011.00 | $7,923.50 | $17,376.00 |