- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,388.44 / $8,912.51
| Facility | | $1,380.38 | $3,388.44 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $9,120.11 / $15,135.61
| Facility | | $5,888.44 | $9,120.11 | $15,135.61 |
- 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
- $1,737.80 / $5,888.44 / $22,387.21
| Facility | | $1,737.80 | $5,888.44 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,754.23 / $5,248.07 / $5,248.07
| Facility | 62 | $2,754.23 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $446.68 / $831.76 / $831.76
| Facility | AS | $446.68 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $15,848.93 / $25,703.96
| Facility | | $5,495.41 | $15,848.93 | $25,703.96 |