- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,168.69 / $7,585.78
| Facility | | $2,570.40 | $4,168.69 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,370.32 / $20,892.96
| Facility | | $1,995.26 | $5,370.32 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Facility | 62 | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | AS | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $741.31
| Facility | | $50.12 | $676.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,511.89 / $8,511.38
| Facility | | $302.00 | $2,511.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $5,888.44 / $15,488.17
| Facility | | $851.14 | $5,888.44 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $12,589.25 / $22,908.68
| Facility | | $2,630.27 | $12,589.25 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,370.32 / $20,892.96
| Facility | | $1,995.26 | $5,370.32 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Facility | 62 | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | AS | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,025.60 / $16,595.87
| Facility | | $2,089.30 | $6,025.60 | $16,595.87 |