- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $18,197.01 / $22,908.68
| Facility | | $6,918.31 | $18,197.01 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $2,630.27
| Facility | | $691.83 | $691.83 | $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
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $18,197.01 / $28,183.83
| Facility | | $6,918.31 | $18,197.01 | $28,183.83 |