- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,495.41 / $14,791.08
| Facility | | $1,862.09 | $5,495.41 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,165.95
| Facility | 22 | $6,165.95 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,022.64 / $22,387.21
| Facility | | $4,365.16 | $12,022.64 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $6,456.54 / $17,782.79
| Facility | | $1,621.81 | $6,456.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | 22 | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | AS | $331.13 | $331.13 | $331.13 |
- 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 |