- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $10,000.00 / $41,686.94
| Facility | | $2,238.72 | $10,000.00 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $38,904.51
| Facility | 22 | $16,218.10 | $16,218.10 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $19,054.61 / $66,069.34
| Facility | | $4,897.79 | $19,054.61 | $66,069.34 |
- 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
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,302.69 / $18,620.87
| Facility | | $4,365.16 | $12,302.69 | $18,620.87 |