- 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
- $9,426.81 / $12,398.83 / $23,983.33
| Facility | | $9,426.81 | $12,398.83 | $23,983.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,215.93 / $7,288.73 / $13,909.00
| Facility | | $4,215.93 | $7,288.73 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $13,549.59 / $13,549.59 / $13,549.59
| Facility | 62 | $13,549.59 | $13,549.59 | $13,549.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,167.94 / $2,167.94 / $2,167.94
| Facility | AS | $2,167.94 | $2,167.94 | $2,167.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,524.00 / $10,422.77 / $14,139.00
| Facility | | $7,524.00 | $10,422.77 | $14,139.00 |
- 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 |