- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.73 / $4,863.05 / $10,087.00
| Facility | | $1,609.73 | $4,863.05 | $10,087.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,033.42 / $3,033.42 / $3,033.42
| Facility | 22 | $3,033.42 | $3,033.42 | $3,033.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,309.50 / $11,950.50 / $23,008.27
| Facility | | $5,309.50 | $11,950.50 | $23,008.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.00 / $956.00 / $1,620.70
| Facility | | $708.00 | $956.00 | $1,620.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.72 / $154.72 / $154.72
| Facility | AS | $154.72 | $154.72 | $154.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.50 / $5,742.00 / $11,732.00
| Facility | | $1,868.50 | $5,742.00 | $11,732.00 |