- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,888.44 / $19,952.62
| Facility | | $1,659.59 | $5,888.44 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $58,884.37
| Facility | 22 | $5,495.41 | $5,495.41 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | 62 | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $12,302.69 / $28,840.32
| Facility | | $5,011.87 | $12,302.69 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,365.16 / $16,982.44
| Facility | | $851.14 | $4,365.16 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | 22 | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | 62 | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | AS | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,332.54 / $23,442.29
| Facility | | $3,019.95 | $9,332.54 | $23,442.29 |