- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $21,899.37
| Facility | | $4,241.22 | $10,431.19 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,101.34 / $3,702.89 / $9,496.00
| Facility | | $2,101.34 | $3,702.89 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,675.87 / $6,872.73 / $6,872.73
| Facility | 62 | $3,675.87 | $6,872.73 | $6,872.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $588.14 / $1,099.64 / $1,099.64
| Facility | AS | $588.14 | $1,099.64 | $1,099.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.16 / $5,286.71 / $7,407.25
| Facility | | $2,740.16 | $5,286.71 | $7,407.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |