- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,896.14 / $4,100.44 / $11,795.55
| Facility | | $1,896.14 | $4,100.44 | $11,795.55 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $6,141.00 / $6,141.00 / $6,141.00
| Facility | 22 | $6,141.00 | $6,141.00 | $6,141.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,693.00 / $11,449.50 / $24,133.67
| Facility | | $4,693.00 | $11,449.50 | $24,133.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.68 / $5,774.82 / $9,965.00
| Facility | | $3,060.68 | $5,774.82 | $9,965.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $217.02 / $217.02 / $217.02
| Facility | AS | $217.02 | $217.02 | $217.02 |
- 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 |