- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $9,332.54 / $18,197.01
| Facility | | $5,128.61 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | 22 | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,548.82
| Facility | | $1,230.27 | $1,230.27 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | 22 | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | 52 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $9,332.54 / $18,197.01
| Facility | | $4,897.79 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | 22 | $11,481.54 | $11,481.54 | $11,481.54 |