- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,903.55 / $6,903.55 / $28,006.83
| Facility | | $6,903.55 | $6,903.55 | $28,006.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,782.52 / $2,139.02 / $2,673.78
| Facility | | $1,782.52 | $2,139.02 | $2,673.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,059.71 / $2,059.71 / $2,059.71
| Facility | | $2,059.71 | $2,059.71 | $2,059.71 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,274.33 / $1,274.33 / $1,274.33
| Facility | 62 | $1,274.33 | $1,274.33 | $1,274.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $203.90 / $203.90 / $203.90
| Facility | AS | $203.90 | $203.90 | $203.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,211.08 / $41,233.18 / $148,029.26
| Facility | | $8,211.08 | $41,233.18 | $148,029.26 |