- 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
- $8,501.19 / $11,521.30 / $21,628.42
| Facility | | $8,501.19 | $11,521.30 | $21,628.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.18 / $1,574.88 / $7,856.00
| Facility | | $1,018.18 | $1,574.88 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,988.85 / $2,988.85 / $2,988.85
| Facility | 62 | $2,988.85 | $2,988.85 | $2,988.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $478.22 / $478.22 / $478.22
| Facility | AS | $478.22 | $478.22 | $478.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.00 / $2,259.66 / $3,109.57
| Facility | | $1,804.00 | $2,259.66 | $3,109.57 |
- 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 |