- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,677.35 / $11,481.54
| Facility | | $1,862.09 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $11,748.98 / $22,387.21
| Facility | | $4,265.80 | $11,748.98 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,495.41 / $15,488.17
| Facility | | $398.11 | $5,495.41 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | 22 | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | 62 | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | AS | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |