- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.63 / $6,685.26 / $13,640.20
| Facility | | $1,650.63 | $6,685.26 | $13,640.20 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $7,085.70 / $7,085.70 / $7,085.70
| Facility | 22 | $7,085.70 | $7,085.70 | $7,085.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,363.00 / $15,579.70
| Facility | | $3,877.00 | $7,363.00 | $15,579.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,793.67 / $2,986.03 / $6,857.08
| Facility | | $1,793.67 | $2,986.03 | $6,857.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.79 / $147.79 / $147.79
| Facility | AS | $147.79 | $147.79 | $147.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,478.00 / $7,221.00 / $11,869.99
| Facility | | $3,478.00 | $7,221.00 | $11,869.99 |