- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.27 / $3,695.07 / $8,364.50
| Facility | | $1,386.27 | $3,695.07 | $8,364.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,785.50 / $11,982.00 / $23,008.27
| Facility | | $5,785.50 | $11,982.00 | $23,008.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,576.22 / $1,576.22 / $2,171.03
| Facility | | $1,576.22 | $1,576.22 | $2,171.03 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $962.11 / $962.11 / $962.11
| Facility | 62 | $962.11 | $962.11 | $962.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $153.94 / $153.94 / $153.94
| Facility | AS | $153.94 | $153.94 | $153.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.00 / $3,236.00 / $6,792.00
| Facility | | $1,367.00 | $3,236.00 | $6,792.00 |