- 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
- $20,988.56 / $27,605.70 / $53,398.33
| Facility | | $20,988.56 | $27,605.70 | $53,398.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,702.55 / $4,011.44 / $13,909.00
| Facility | | $2,702.55 | $4,011.44 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $6,801.77 / $6,801.77 / $6,801.77
| Facility | 62 | $6,801.77 | $6,801.77 | $6,801.77 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,088.28 / $1,088.28 / $1,088.28
| Facility | AS | $1,088.28 | $1,088.28 | $1,088.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,250.97 / $5,282.76 / $7,118.94
| Facility | | $4,250.97 | $5,282.76 | $7,118.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |