- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $9,120.11 / $32,359.37
| Facility | | $2,041.74 | $9,120.11 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $17,782.79 / $34,673.69
| Facility | | $1,819.70 | $17,782.79 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $3,090.30
| Facility | | $891.25 | $891.25 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | 22 | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | 62 | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | AS | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,398.83 / $4,073.80
| Facility | | $1,819.70 | $2,398.83 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $23,442.29 / $43,651.58
| Facility | | $5,754.40 | $23,442.29 | $43,651.58 |