- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $6,456.54 / $19,498.45
| Facility | | $1,318.26 | $6,456.54 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $0.33 / $2,691.53 / $8,511.38
| Facility | 22 | $0.33 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $11,220.18 / $24,547.09
| Facility | | $3,890.45 | $11,220.18 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,467.37 / $11,748.98
| Facility | | $1,659.59 | $3,467.37 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | 22 | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,912.51 / $20,892.96
| Facility | | $3,019.95 | $8,912.51 | $20,892.96 |