- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,691.53 / $9,120.11
| Facility | | $295.12 | $2,691.53 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,585.78 / $19,054.61
| Facility | | $2,630.27 | $7,585.78 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $14,791.08 / $15,488.17
| Facility | | $436.52 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | 22 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | 62 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Facility | AS | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $512.86
| Facility | | $245.47 | $302.00 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,737.80 / $18,197.01
| Facility | | $354.81 | $1,737.80 | $18,197.01 |