- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.68 / $4,833.50 / $14,223.26
| Facility | | $1,206.68 | $4,833.50 | $14,223.26 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $8,865.61 / $8,865.61 / $10,259.77
| Facility | 22 | $8,865.61 | $8,865.61 | $10,259.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,432.00 / $8,113.00 / $17,400.00
| Facility | | $4,432.00 | $8,113.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,012.85 / $3,626.26 / $4,644.55
| Facility | | $3,012.85 | $3,626.26 | $4,644.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $79.45 / $79.45 / $79.45
| Facility | AS | $79.45 | $79.45 | $79.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,220.00 / $14,242.22
| Facility | | $4,062.00 | $8,220.00 | $14,242.22 |