- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,818.38 / $10,471.29
| Facility | | $776.25 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $10,964.78 / $18,620.87
| Facility | | $4,677.35 | $10,964.78 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,041.74 / $9,772.37
| Facility | | $741.31 | $2,041.74 | $9,772.37 |
- 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
- $812.83 / $812.83 / $812.83
| Facility | 62 | $812.83 | $812.83 | $812.83 |
- 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 / $5,495.41
| Facility | | $269.15 | $1,202.26 | $5,495.41 |