- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,754.23 / $7,943.28
| Facility | | $1,258.93 | $2,754.23 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $12,302.69 / $18,620.87
| Facility | | $5,754.40 | $12,302.69 | $18,620.87 |
- 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
- $54.95 / $18,620.87 / $18,620.87
| Facility | | $54.95 | $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
- $8,128.31 / $12,882.50 / $22,908.68
| Facility | | $8,128.31 | $12,882.50 | $22,908.68 |