- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $9,120.11 / $26,302.68
| Facility | | $2,137.96 | $9,120.11 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,365.16 / $13,182.57 / $25,118.86
| Facility | 22 | $4,365.16 | $13,182.57 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | AS | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $13,803.84 / $28,840.32
| Facility | | $5,011.87 | $13,803.84 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,786.30 / $23,988.33
| Facility | | $1,548.82 | $4,786.30 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | 22 | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,120.11 / $20,892.96
| Facility | | $3,019.95 | $9,120.11 | $20,892.96 |