- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,606.93 / $22,908.68
| Facility | | $2,089.30 | $6,606.93 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,309.57 / $14,125.38
| Facility | | $2,344.23 | $6,309.57 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $18,620.87 / $22,908.68
| Facility | | $8,709.64 | $18,620.87 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,344.23 / $7,079.46
| Facility | | $1,412.54 | $2,344.23 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $13,182.57
| Facility | 62 | $2,344.23 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $371.54 / $2,089.30 / $2,089.30
| Facility | AS | $371.54 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $11,481.54
| Facility | | $2,884.03 | $5,128.61 | $11,481.54 |