- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.16 / $5,168.00 / $10,356.71
| Facility | | $1,775.16 | $5,168.00 | $10,356.71 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $9,969.75 / $9,969.75 / $9,969.75
| Facility | 22 | $9,969.75 | $9,969.75 | $9,969.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $9,565.00 / $17,774.00
| Facility | | $6,996.00 | $9,565.00 | $17,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,105.50 / $2,937.52 / $4,528.38
| Facility | | $2,105.50 | $2,937.52 | $4,528.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $168.44 / $168.44 / $168.44
| Facility | AS | $168.44 | $168.44 | $168.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $8,072.00 / $14,242.22
| Facility | | $3,028.00 | $8,072.00 | $14,242.22 |