- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,818.38 / $7,585.78
| Facility | | $1,258.93 | $2,818.38 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,454.71 / $4,897.79
| Facility | | $1,258.93 | $2,454.71 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $18,620.87 / $18,620.87
| Facility | | $1,995.26 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | 62 | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | AS | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,754.40 / $10,232.93
| Facility | | $3,235.94 | $5,754.40 | $10,232.93 |