- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,511.89 / $8,912.51
| Facility | | $1,202.26 | $2,511.89 | $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
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,467.37 / $17,378.01
| Facility | | $1,348.96 | $3,467.37 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,995.26 / $3,801.89 / $3,801.89
| Facility | 62 | $1,995.26 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $323.59 / $602.56 / $602.56
| Facility | AS | $323.59 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $11,748.98 / $21,379.62
| Facility | | $3,235.94 | $11,748.98 | $21,379.62 |