- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,495.41 / $13,803.84
| Facility | | $1,621.81 | $5,495.41 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | 22 | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $11,481.54 / $22,908.68
| Facility | | $4,168.69 | $11,481.54 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,981.07 / $11,220.18
| Facility | | $398.11 | $3,981.07 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Facility | 22 | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Facility | AS | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,786.30 / $11,220.18
| Facility | | $1,513.56 | $4,786.30 | $11,220.18 |