- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,195.75 / $12,462.61 / $23,395.49
| Facility | | $9,195.75 | $12,462.61 | $23,395.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,331.83 / $2,216.87 / $7,856.00
| Facility | | $1,331.83 | $2,216.87 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,920.79 / $3,920.79 / $3,920.79
| Facility | 62 | $3,920.79 | $3,920.79 | $3,920.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $627.33 / $627.33 / $627.33
| Facility | AS | $627.33 | $627.33 | $627.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,409.00 / $3,015.99 / $4,098.63
| Facility | | $2,409.00 | $3,015.99 | $4,098.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,126.00 / $4,317.00 / $7,856.00
| Facility | | $3,126.00 | $4,317.00 | $7,856.00 |