- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.24 / $4,740.00 / $9,875.42
| Facility | | $1,454.24 | $4,740.00 | $9,875.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $9,565.00 / $17,774.00
| Facility | | $6,996.00 | $9,565.00 | $17,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,211.00 / $3,851.90 / $5,666.74
| Facility | | $2,211.00 | $3,851.90 | $5,666.74 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $913.41 / $913.41 / $913.41
| Facility | 62 | $913.41 | $913.41 | $913.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $146.15 / $146.15 / $146.15
| Facility | AS | $146.15 | $146.15 | $146.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,576.00 / $14,242.22
| Facility | | $3,028.00 | $7,576.00 | $14,242.22 |