- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.86 / $7,414.00 / $17,080.74
| Facility | | $1,713.86 | $7,414.00 | $17,080.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,632.16 / $32,422.94 / $66,228.75
| Facility | | $8,632.16 | $32,422.94 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,147.70 / $5,884.98 / $14,157.12
| Facility | | $4,147.70 | $5,884.98 | $14,157.12 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,274.33 / $1,274.33 / $1,274.33
| Facility | 62 | $1,274.33 | $1,274.33 | $1,274.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $203.90 / $203.90 / $203.90
| Facility | AS | $203.90 | $203.90 | $203.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,770.63 / $5,380.28 / $11,147.34
| Facility | | $3,770.63 | $5,380.28 | $11,147.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,830.72 / $3,455.76 / $12,736.54
| Facility | | $1,830.72 | $3,455.76 | $12,736.54 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,770.67 / $2,770.67 / $2,770.67
| Facility | 62 | $2,770.67 | $2,770.67 | $2,770.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $443.31 / $443.31 / $443.31
| Facility | AS | $443.31 | $443.31 | $443.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,276.00 / $12,506.00 / $25,695.00
| Facility | | $6,276.00 | $12,506.00 | $25,695.00 |