- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,818.38 / $10,471.29
| Facility | | $549.54 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,511.38 / $16,982.44
| Facility | | $4,570.88 | $8,511.38 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,096.48 / $15,135.61
| Facility | | $512.86 | $1,096.48 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | 22 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Facility | 62 | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.07 / $66.07 / $66.07
| Facility | AS | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,230.27 / $3,981.07
| Facility | | $269.15 | $1,230.27 | $3,981.07 |