- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,280.75 / $4,824.50 / $10,189.12
| Facility | | $1,280.75 | $4,824.50 | $10,189.12 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $24,958.86 / $24,958.86 / $24,958.86
| Facility | 22 | $24,958.86 | $24,958.86 | $24,958.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.00 / $7,565.00 / $15,579.70
| Facility | | $4,100.00 | $7,565.00 | $15,579.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.97 / $2,388.98 / $6,857.08
| Facility | | $1,433.97 | $2,388.98 | $6,857.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $118.15 / $118.15 / $118.15
| Facility | AS | $118.15 | $118.15 | $118.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,367.50 / $6,906.00 / $11,831.32
| Facility | | $3,367.50 | $6,906.00 | $11,831.32 |