- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,162.28 / $3,162.28
| Facility | | $1,412.54 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $4,073.80
| Facility | | $3,311.31 | $3,311.31 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $5,248.07 / $5,248.07
| Facility | | $34.67 | $5,248.07 | $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
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |