- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $7,943.28 / $20,892.96
| Facility | | $1,513.56 | $7,943.28 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $6,456.54
| Facility | 62 | $6,456.54 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $10,000.00 / $30,199.52
| Facility | | $398.11 | $10,000.00 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 22 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | 62 | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | AS | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $11,748.98 / $22,908.68
| Facility | | $5,623.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,748.98 / $18,620.87
| Facility | | $3,715.35 | $11,748.98 | $18,620.87 |