- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,235.94 / $10,471.29
| Facility | | $660.69 | $3,235.94 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,760.83 / $13,803.84
| Facility | | $2,630.27 | $6,760.83 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $891.25 / $9,772.37
| Facility | | $380.19 | $891.25 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | 22 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | 62 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Facility | AS | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,202.26 / $5,370.32
| Facility | | $269.15 | $1,202.26 | $5,370.32 |