- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,382.47 / $5,915.00 / $13,870.25
| Facility | | $1,382.47 | $5,915.00 | $13,870.25 |
- 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
- $7,813.00 / $12,132.66 / $19,065.61
| Facility | | $7,813.00 | $12,132.66 | $19,065.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $999.52 / $1,730.05 / $12,719.00
| Facility | | $999.52 | $1,730.05 | $12,719.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,632.21 / $2,632.21 / $2,632.21
| Facility | AS | $2,632.21 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.00 / $6,980.00 / $13,541.98
| Facility | | $1,570.00 | $6,980.00 | $13,541.98 |