- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $7,233.00 / $11,600.00
| Facility | | $2,114.00 | $7,233.00 | $11,600.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,125.00 / $5,125.00 / $5,125.00
| Facility | 22 | $5,125.00 | $5,125.00 | $5,125.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.70 / $3,279.50 / $5,692.58
| Facility | | $778.70 | $3,279.50 | $5,692.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,019.71 / $9,019.71 / $9,019.71
| Facility | | $9,019.71 | $9,019.71 | $9,019.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.89 / $1,316.16 / $9,383.00
| Facility | | $865.89 | $1,316.16 | $9,383.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $230.68 / $2,632.21 / $2,632.21
| Facility | AS | $230.68 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $7,341.00 / $11,396.00
| Facility | | $5,315.00 | $7,341.00 | $11,396.00 |