- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $10,964.78 / $21,877.62
| Facility | | $3,019.95 | $10,964.78 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,413.10 / $18,620.87
| Facility | | $2,951.21 | $7,413.10 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $14,791.08 / $15,488.17
| Facility | | $2,344.23 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | 22 | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | 62 | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $2,570.40
| Professional | | $1,819.70 | $1,819.70 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,513.56 / $2,754.23
| Facility | | $1,071.52 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $18,197.01 / $25,703.96
| Facility | | $4,677.35 | $18,197.01 | $25,703.96 |