- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $16,595.87 / $22,908.68
| Facility | | $14,125.38 | $16,595.87 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Facility | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | 22 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Facility | 62 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Facility | AS | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $1,548.82
| Facility | | $251.19 | $588.84 | $1,548.82 |