- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,301.48 / $4,443.50 / $8,861.13
| Facility | | $2,301.48 | $4,443.50 | $8,861.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $16,401.00 / $29,216.95
| Facility | | $8,512.20 | $16,401.00 | $29,216.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,733.97
| Facility | | $895.00 | $950.00 | $2,733.97 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,688.18 / $1,688.18 / $1,688.18
| Facility | 62 | $1,688.18 | $1,688.18 | $1,688.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $270.11 / $270.11 / $270.11
| Facility | AS | $270.11 | $270.11 | $270.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |