- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $7,244.36 / $21,877.62
| Facility | | $1,513.56 | $7,244.36 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $6,456.54 / $13,489.63 / $14,125.38
| Facility | 22 | $6,456.54 | $13,489.63 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $14,791.08 / $25,703.96
| Facility | | $5,011.87 | $14,791.08 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,290.87 / $25,703.96
| Facility | | $489.78 | $2,290.87 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | 22 | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $8,317.64 / $20,892.96
| Facility | | $2,089.30 | $8,317.64 | $20,892.96 |