- 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
- $6,416.80 / $9,302.56 / $16,325.39
| Facility | | $6,416.80 | $9,302.56 | $16,325.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.30 / $543.03 / $837.19
| Facility | | $310.30 | $543.03 | $837.19 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $992.48 / $992.48 / $992.48
| Facility | 62 | $992.48 | $992.48 | $992.48 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.80 / $158.80 / $158.80
| Facility | AS | $158.80 | $158.80 | $158.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.00 / $763.45 / $1,086.64
| Facility | | $601.00 | $763.45 | $1,086.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |