- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $5,011.87 / $11,748.98
| Facility | | $1,096.48 | $5,011.87 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | 22 | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,511.38 / $16,218.10
| Facility | | $3,388.44 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,511.89 / $5,888.44
| Facility | | $1,230.27 | $2,511.89 | $5,888.44 |
- 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
- 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
- $1,348.96 / $5,248.07 / $13,182.57
| Facility | | $1,348.96 | $5,248.07 | $13,182.57 |