- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,454.71 / $7,585.78
| Facility | | $933.25 | $2,454.71 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $6,456.54
| Facility | | $109.65 | $151.36 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | 62 | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | AS | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,585.78 / $12,302.69
| Facility | | $4,365.16 | $7,585.78 | $12,302.69 |