- 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
- $1,336.39 / $2,338.67 / $8,220.00
| Facility | | $1,336.39 | $2,338.67 | $8,220.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,355.23 / $4,376.83 / $4,376.83
| Facility | 62 | $2,355.23 | $4,376.83 | $4,376.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $376.84 / $700.29 / $700.29
| Facility | AS | $376.84 | $700.29 | $700.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,703.03 / $3,340.65 / $4,676.06
| Facility | | $1,703.03 | $3,340.65 | $4,676.06 |
- 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 |