- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $5,623.41 / $17,378.01
| Facility | | $1,174.90 | $5,623.41 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,630.27 / $6,309.57 / $17,782.79
| Facility | 22 | $2,630.27 | $6,309.57 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,079.46 / $18,197.01
| Facility | | $3,311.31 | $7,079.46 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,454.71 / $11,481.54
| Facility | | $1,202.26 | $2,454.71 | $11,481.54 |
- 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 |