- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $8,511.38 / $28,183.83
| Facility | | $1,862.09 | $8,511.38 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,897.79 / $15,848.93 / $38,904.51
| Facility | 22 | $4,897.79 | $15,848.93 | $38,904.51 |
- 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
- $1,380.38 / $4,365.16 / $19,054.61
| Facility | | $1,380.38 | $4,365.16 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | 22 | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | AS | $208.93 | $208.93 | $208.93 |
- 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 |