- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,897.79 / $8,912.51
| Facility | | $1,445.44 | $4,897.79 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $22,908.68
| Facility | | $8,912.51 | $13,803.84 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $14,454.40
| Facility | | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,168.69 / $15,488.17
| Facility | | $1,698.24 | $4,168.69 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,570.40 / $30,199.52 / $30,199.52
| Facility | 62 | $2,570.40 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $416.87 / $4,897.79 / $4,897.79
| Facility | AS | $416.87 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $8,128.31 / $15,135.61
| Facility | | $1,949.84 | $8,128.31 | $15,135.61 |