- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.52 / $576.30 / $1,775.00
| Facility | | $311.52 | $576.30 | $1,775.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $541.99 / $1,020.88 / $1,020.88
| Facility | 62 | $541.99 | $1,020.88 | $1,020.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.72 / $163.34 / $163.34
| Facility | AS | $86.72 | $163.34 | $163.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.11 / $785.30 / $1,105.42
| Facility | | $413.11 | $785.30 | $1,105.42 |
- 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 |