- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $7,762.47 / $27,542.29
| Facility | | $2,041.74 | $7,762.47 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $20,417.38 / $29,512.09 / $29,512.09
| Facility | 22 | $20,417.38 | $29,512.09 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | AS | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $8,912.51 / $25,703.96
| Facility | | $1,819.70 | $8,912.51 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $4,073.80 / $32,359.37
| Facility | | $489.78 | $4,073.80 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 22 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | AS | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $7,585.78 / $19,054.61
| Facility | | $2,089.30 | $7,585.78 | $19,054.61 |