- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,014.01 / $8,642.22 / $21,358.74
| Facility | | $2,014.01 | $8,642.22 | $21,358.74 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $9,191.88 / $9,433.18 / $9,845.60
| Facility | 22 | $9,191.88 | $9,433.18 | $9,845.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $10,588.00 / $22,609.00
| Facility | | $4,989.00 | $10,588.00 | $22,609.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,151.33 / $6,561.47 / $8,005.08
| Facility | | $5,151.33 | $6,561.47 | $8,005.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $136.90 / $136.90 / $136.90
| Facility | AS | $136.90 | $136.90 | $136.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,220.00 / $14,242.22
| Facility | | $4,062.00 | $8,220.00 | $14,242.22 |