- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,456.54 / $21,379.62
| Facility | | $1,778.28 | $6,456.54 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $18,620.87 / $28,840.32 / $28,840.32
| Facility | 22 | $18,620.87 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,589.25 / $33,113.11
| Facility | | $4,466.84 | $12,589.25 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $5,128.61 / $15,848.93
| Facility | | $512.86 | $5,128.61 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | 22 | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Facility | AS | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $12,022.64 / $32,359.37
| Facility | | $3,630.78 | $12,022.64 | $32,359.37 |