- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,025.60 / $19,952.62
| Facility | | $1,905.46 | $6,025.60 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $14,454.40
| Facility | 22 | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $13,803.84 / $29,512.09
| Facility | | $5,011.87 | $13,803.84 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,466.84 / $15,135.61
| Facility | | $398.11 | $4,466.84 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | 22 | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | 62 | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | AS | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $14,125.38 / $37,153.52
| Facility | | $3,981.07 | $14,125.38 | $37,153.52 |