- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,244.36 / $14,791.08
| Facility | | $2,398.83 | $7,244.36 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $602.56 / $2,630.27
| Facility | | $575.44 | $602.56 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | 22 | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | 62 | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Facility | AS | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,621.81 / $2,344.23
| Professional | | $1,258.93 | $1,621.81 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $6,165.95
| Facility | | $1,548.82 | $2,238.72 | $6,165.95 |