- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,453.17 / $9,520.00 / $23,483.17
| Facility | | $3,453.17 | $9,520.00 | $23,483.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.83 / $15,476.59 / $29,936.73
| Facility | | $11,766.83 | $15,476.59 | $29,936.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,578.90 / $2,786.26 / $18,824.49
| Facility | | $1,578.90 | $2,786.26 | $18,824.49 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,770.67 / $5,209.43 / $5,209.43
| Facility | 62 | $2,770.67 | $5,209.43 | $5,209.43 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $443.31 / $833.51 / $833.51
| Facility | AS | $443.31 | $833.51 | $833.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,105.91 / $4,007.25 / $5,724.10
| Facility | | $2,105.91 | $4,007.25 | $5,724.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,617.00 / $11,459.00 / $26,782.00
| Facility | | $9,617.00 | $11,459.00 | $26,782.00 |