- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.14 / $6,063.50 / $13,214.48
| Facility | | $1,433.14 | $6,063.50 | $13,214.48 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,388.30 / $3,388.30 / $3,388.30
| Facility | 22 | $3,388.30 | $3,388.30 | $3,388.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,137.83 / $12,033.50 / $20,715.50
| Facility | | $6,137.83 | $12,033.50 | $20,715.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.90 / $1,161.90 / $3,254.23
| Facility | | $1,161.90 | $1,161.90 | $3,254.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.16 / $114.16 / $114.16
| Facility | AS | $114.16 | $114.16 | $114.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,810.00
| Facility | | $2,637.00 | $5,735.00 | $9,810.00 |