- 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
- $9,823.60 / $13,313.50 / $24,992.84
| Facility | | $9,823.60 | $13,313.50 | $24,992.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.73 / $2,135.09 / $7,856.00
| Facility | | $1,244.73 | $2,135.09 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,618.02 / $3,618.02 / $3,618.02
| Facility | 62 | $3,618.02 | $3,618.02 | $3,618.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $578.88 / $578.88 / $578.88
| Facility | AS | $578.88 | $578.88 | $578.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,205.00 / $2,804.71 / $3,900.19
| Facility | | $2,205.00 | $2,804.71 | $3,900.19 |
- 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 |