- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.75 / $5,602.52 / $6,173.66
| Facility | | $933.75 | $5,602.52 | $6,173.66 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $38,469.14 / $38,469.14 / $38,469.14
| Facility | 22 | $38,469.14 | $38,469.14 | $38,469.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $24,475.14 / $24,475.14 / $24,475.14
| Facility | AS | $24,475.14 | $24,475.14 | $24,475.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.42 / $5,970.20 / $24,638.08
| Facility | | $955.42 | $5,970.20 | $24,638.08 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $38,469.14 / $38,469.14 / $38,469.14
| Facility | 22 | $38,469.14 | $38,469.14 | $38,469.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $24,475.14 / $24,475.14 / $24,475.14
| Facility | AS | $24,475.14 | $24,475.14 | $24,475.14 |