- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $7,762.47 / $20,417.38
| Facility | | $1,513.56 | $7,762.47 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $10,715.19 / $15,848.93 / $30,199.52
| Facility | 22 | $10,715.19 | $15,848.93 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,715.19 / $21,877.62
| Facility | | $3,801.89 | $10,715.19 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,818.38 / $7,762.47
| Facility | | $1,000.00 | $2,818.38 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | 22 | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- 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 |