- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $10,232.93 / $28,840.32
| Facility | | $1,949.84 | $10,232.93 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $10,715.19 / $22,908.68
| Facility | | $2,398.83 | $10,715.19 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $12,882.50 / $14,791.08
| Facility | | $2,884.03 | $12,882.50 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | 22 | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | 62 | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Facility | AS | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,981.07
| Professional | | $3,388.44 | $3,388.44 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,238.72 / $3,801.89
| Facility | | $1,659.59 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $20,417.38 / $25,703.96
| Facility | | $8,709.64 | $20,417.38 | $25,703.96 |