- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,623.41 / $16,595.87
| Facility | | $1,513.56 | $5,623.41 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $13,803.84 / $30,199.52
| Facility | | $5,011.87 | $13,803.84 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,630.78 / $16,595.87
| Facility | | $630.96 | $3,630.78 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | 22 | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | 62 | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.87 / $223.87 / $223.87
| Facility | AS | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $11,481.54 / $31,622.78
| Facility | | $3,548.13 | $11,481.54 | $31,622.78 |