- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $6,760.83 / $15,488.17
| Facility | | $1,621.81 | $6,760.83 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $16,982.44
| Facility | 22 | $16,982.44 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $13,803.84 / $26,915.35
| Facility | | $4,466.84 | $13,803.84 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,011.87 / $20,417.38
| Facility | | $1,202.26 | $5,011.87 | $20,417.38 |
- 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
- $2,137.96 / $8,317.64 / $19,498.45
| Facility | | $2,137.96 | $8,317.64 | $19,498.45 |