- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.44 / $4,657.00 / $10,527.00
| Facility | | $1,348.44 | $4,657.00 | $10,527.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,305.00 / $24,163.00 / $64,800.00
| Facility | | $7,305.00 | $24,163.00 | $64,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,463.39 / $1,463.39
| Facility | | $1,000.00 | $1,463.39 | $1,463.39 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $908.75 / $908.75 / $908.75
| Facility | 62 | $908.75 | $908.75 | $908.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $145.40 / $145.40 / $145.40
| Facility | AS | $145.40 | $145.40 | $145.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $21,600.00
| Facility | | $4,505.00 | $10,133.00 | $21,600.00 |