- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $7,876.32 / $33,179.50
| Facility | | $1,400.00 | $7,876.32 | $33,179.50 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $9,691.20 / $9,691.20 / $9,691.20
| Facility | 22 | $9,691.20 | $9,691.20 | $9,691.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,168.56 / $1,577.56 / $1,928.12
| Facility | | $1,168.56 | $1,577.56 | $1,928.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,393.58 / $1,393.58 / $1,393.58
| Facility | | $1,393.58 | $1,393.58 | $1,393.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $136.90 / $136.90 / $136.90
| Facility | AS | $136.90 | $136.90 | $136.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,338.46 / $45,764.19 / $50,262.89
| Facility | | $21,338.46 | $45,764.19 | $50,262.89 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $23,250.43 / $23,250.43 / $23,250.43
| Facility | 22 | $23,250.43 | $23,250.43 | $23,250.43 |