- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,677.35 / $11,748.98
| Facility | | $1,513.56 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,000.00 / $18,197.01
| Facility | | $3,801.89 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $4,265.80 / $11,748.98
| Facility | | $323.59 | $4,265.80 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | 62 | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Facility | AS | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |