- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,805.10 / $3,907.50 / $8,074.63
| Facility | | $1,805.10 | $3,907.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.10 / $8,981.00 / $15,216.00
| Facility | | $4,769.10 | $8,981.00 | $15,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,921.18 / $1,921.18 / $4,925.29
| Facility | | $1,921.18 | $1,921.18 | $4,925.29 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,162.27 / $1,162.27 / $1,162.27
| Facility | 62 | $1,162.27 | $1,162.27 | $1,162.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $185.96 / $185.96 / $185.96
| Facility | AS | $185.96 | $185.96 | $185.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |