- 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
- $8,283.48 / $11,226.25 / $21,074.53
| Facility | | $8,283.48 | $11,226.25 | $21,074.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.54 / $3,661.76 / $7,856.00
| Facility | | $2,120.54 | $3,661.76 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $6,161.22 / $6,161.22 / $6,161.22
| Facility | 62 | $6,161.22 | $6,161.22 | $6,161.22 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $985.80 / $985.80 / $985.80
| Facility | AS | $985.80 | $985.80 | $985.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,771.00 / $4,739.39 / $6,674.93
| Facility | | $3,771.00 | $4,739.39 | $6,674.93 |
- 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 |