- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.66 / $5,412.00 / $11,100.08
| Facility | | $1,547.66 | $5,412.00 | $11,100.08 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $12,412.02 / $12,412.02 / $12,412.02
| Facility | 22 | $12,412.02 | $12,412.02 | $12,412.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,692.00 / $9,644.00 / $17,400.00
| Facility | | $5,692.00 | $9,644.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,567.52 / $2,000.00 / $4,720.73
| Facility | | $1,567.52 | $2,000.00 | $4,720.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $155.62 / $155.62 / $155.62
| Facility | AS | $155.62 | $155.62 | $155.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,832.00 / $3,972.00 / $8,339.00
| Facility | | $1,832.00 | $3,972.00 | $8,339.00 |