- 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
- $18,424.50 / $24,233.27 / $46,874.97
| Facility | | $18,424.50 | $24,233.27 | $46,874.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.28 / $2,296.61 / $13,909.00
| Facility | | $1,518.28 | $2,296.61 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,114.74 / $4,114.74 / $4,114.74
| Facility | 62 | $4,114.74 | $4,114.74 | $4,114.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $658.36 / $658.36 / $658.36
| Facility | AS | $658.36 | $658.36 | $658.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,515.00 / $3,194.70 / $4,284.97
| Facility | | $2,515.00 | $3,194.70 | $4,284.97 |
- 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 |