- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,570.40 / $8,511.38
| Facility | | $758.58 | $2,570.40 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $10,471.29 / $18,197.01
| Facility | | $4,677.35 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,621.81 / $5,011.87
| Facility | | $630.96 | $1,621.81 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | 22 | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | 62 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | AS | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,202.26 / $3,801.89
| Facility | | $269.15 | $1,202.26 | $3,801.89 |