- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,943.28 / $23,442.29
| Facility | | $1,949.84 | $7,943.28 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $38,904.51 / $38,904.51 / $38,904.51
| Facility | 22 | $38,904.51 | $38,904.51 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,589.25 / $28,840.32
| Facility | | $4,677.35 | $12,589.25 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,011.87 / $16,595.87
| Facility | | $1,513.56 | $5,011.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | 22 | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Facility | AS | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,912.51 / $20,417.38
| Facility | | $3,019.95 | $8,912.51 | $20,417.38 |