- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,388.44 / $28,840.32
| Facility | | $1,479.11 | $3,388.44 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,022.64 / $28,183.83
| Facility | | $7,413.10 | $12,022.64 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | 22 | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | 62 | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | AS | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $11,481.54 / $22,387.21
| Facility | | $9,120.11 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,786.30 / $9,549.93
| Facility | | $3,090.30 | $4,786.30 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,311.31 / $8,511.38
| Facility | | $794.33 | $3,311.31 | $8,511.38 |