- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,401.86 / $6,544.35 / $12,977.00
| Facility | | $1,401.86 | $6,544.35 | $12,977.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,696.50 / $2,696.50 / $2,696.50
| Facility | 22 | $2,696.50 | $2,696.50 | $2,696.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $9,830.00 / $17,658.00
| Facility | | $4,989.00 | $9,830.00 | $17,658.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,065.01 / $5,065.01 / $6,763.00
| Facility | | $5,065.01 | $5,065.01 | $6,763.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.09 / $109.09 / $109.09
| Facility | AS | $109.09 | $109.09 | $109.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,220.00 / $14,242.22
| Facility | | $4,062.00 | $8,220.00 | $14,242.22 |