- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,595.11 / $3,729.85 / $8,238.00
| Facility | | $1,595.11 | $3,729.85 | $8,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,636.21 / $8,932.23 / $14,405.53
| Facility | | $4,636.21 | $8,932.23 | $14,405.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.40 / $1,664.40 / $4,473.79
| Facility | | $1,664.40 | $1,664.40 | $4,473.79 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,013.84 / $1,013.84 / $1,013.84
| Facility | 62 | $1,013.84 | $1,013.84 | $1,013.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.21 / $162.21 / $162.21
| Facility | AS | $162.21 | $162.21 | $162.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |