- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $6,165.95 / $15,848.93
| Facility | | $1,412.54 | $6,165.95 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,511.89 / $4,265.80 / $4,265.80
| Facility | 22 | $2,511.89 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,589.25 / $23,442.29
| Facility | | $4,466.84 | $12,589.25 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,454.71 / $7,762.47
| Facility | | $398.11 | $2,454.71 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | 22 | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | AS | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,025.60 / $12,302.69
| Facility | | $1,905.46 | $6,025.60 | $12,302.69 |