- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $6,918.31 / $15,848.93
| Facility | | $1,445.44 | $6,918.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,073.80 / $7,079.46 / $20,892.96
| Facility | 22 | $4,073.80 | $7,079.46 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $10,471.29 / $20,892.96
| Facility | | $3,715.35 | $10,471.29 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,090.30 / $19,054.61
| Facility | | $1,148.15 | $3,090.30 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | 22 | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.23 / $120.23 / $120.23
| Facility | AS | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |