- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $8,317.64 / $16,595.87
| Facility | | $3,630.78 | $8,317.64 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $5,248.07
| Facility | | $34.67 | $562.34 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $6,309.57
| Facility | 22 | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Facility | 62 | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | AS | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,073.80 / $4,786.30
| Professional | | $4,073.80 | $4,073.80 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,073.80 / $6,606.93
| Facility | | $3,090.30 | $4,073.80 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $6,165.95 / $8,912.51
| Facility | | $478.63 | $6,165.95 | $8,912.51 |