- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,754.23 / $8,912.51
| Facility | | $1,258.93 | $2,754.23 | $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
- $1,318.26 / $3,467.37 / $17,378.01
| Facility | | $1,318.26 | $3,467.37 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,995.26 / $3,715.35 / $3,715.35
| Facility | 62 | $1,995.26 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $316.23 / $588.84 / $588.84
| Facility | AS | $316.23 | $588.84 | $588.84 |
- 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 |