- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,495.41 / $13,803.84
| Facility | | $1,445.44 | $5,495.41 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $25,118.86
| Facility | 22 | $25,118.86 | $25,118.86 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,481.54 / $22,387.21
| Facility | | $3,981.07 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,235.94 / $11,481.54
| Facility | | $398.11 | $3,235.94 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | 22 | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Facility | AS | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,218.10
| Facility | | $2,454.71 | $7,244.36 | $16,218.10 |