- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,754.40 / $16,982.44
| Facility | | $1,318.26 | $5,754.40 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $9,549.93
| Facility | 22 | $8,709.64 | $8,709.64 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,481.54 / $19,498.45
| Facility | | $3,630.78 | $11,481.54 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,630.27 / $26,915.35
| Facility | | $549.54 | $2,630.27 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | 22 | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $10,471.29 / $26,302.68
| Facility | | $2,884.03 | $10,471.29 | $26,302.68 |