- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.85 / $3,908.01 / $13,841.56
| Facility | | $654.85 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.40 / $10,296.48 / $19,916.72
| Facility | | $7,828.40 | $10,296.48 | $19,916.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.85 / $1,145.99 / $2,174.92
| Facility | | $654.85 | $1,145.99 | $2,174.92 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,139.24 / $2,168.54 / $2,168.54
| Facility | 62 | $1,139.24 | $2,168.54 | $2,168.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.28 / $346.97 / $346.97
| Facility | AS | $182.28 | $346.97 | $346.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.98 / $1,668.11 / $2,346.37
| Facility | | $867.98 | $1,668.11 | $2,346.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |