- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,888.44 / $9,772.37
| Facility | | $2,344.23 | $5,888.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,888.44 / $9,120.11
| Facility | | $1,659.59 | $5,888.44 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,754.23 / $19,952.62
| Facility | | $1,621.81 | $2,754.23 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $5,248.07
| Facility | 62 | $2,754.23 | $2,754.23 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $446.68 / $446.68 / $831.76
| Facility | AS | $446.68 | $446.68 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $14,791.08 / $24,547.09
| Facility | | $4,570.88 | $14,791.08 | $24,547.09 |