- 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
- $12,669.97 / $18,367.90 / $32,234.47
| Facility | | $12,669.97 | $18,367.90 | $32,234.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,062.96 / $3,486.42 / $4,913.88
| Facility | | $2,062.96 | $3,486.42 | $4,913.88 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $6,641.86 / $6,641.86 / $6,641.86
| Facility | 62 | $6,641.86 | $6,641.86 | $6,641.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,062.70 / $1,062.70 / $1,062.70
| Facility | AS | $1,062.70 | $1,062.70 | $1,062.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,720.00 / $5,109.12 / $7,091.45
| Facility | | $3,720.00 | $5,109.12 | $7,091.45 |
- 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 |