- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $7,506.56 / $12,858.69
| Facility | | $1,671.00 | $7,506.56 | $12,858.69 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $6,071.53 / $6,071.53 / $6,202.00
| Facility | 22 | $6,071.53 | $6,071.53 | $6,202.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $6,042.30 / $6,042.30 / $6,042.30
| Facility | AS | $6,042.30 | $6,042.30 | $6,042.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,169.00 / $9,458.00 / $18,603.00
| Facility | | $4,169.00 | $9,458.00 | $18,603.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.68 / $901.00 / $2,656.00
| Facility | | $686.68 | $901.00 | $2,656.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.78 / $67.78 / $67.78
| Facility | AS | $67.78 | $67.78 | $67.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,194.50 / $6,927.00 / $13,246.50
| Facility | | $2,194.50 | $6,927.00 | $13,246.50 |