- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,178.42 / $4,166.00 / $8,074.63
| Facility | | $2,178.42 | $4,166.00 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,321.00 / $11,242.77 / $19,959.86
| Facility | | $5,321.00 | $11,242.77 | $19,959.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,478.02 / $2,478.02 / $3,403.50
| Facility | | $2,478.02 | $2,478.02 | $3,403.50 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,508.29 / $1,508.29 / $1,508.29
| Facility | 62 | $1,508.29 | $1,508.29 | $1,508.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $241.33 / $241.33 / $241.33
| Facility | AS | $241.33 | $241.33 | $241.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |