- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,235.94 / $10,964.78
| Facility | | $933.25 | $3,235.94 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $9,120.11 / $17,782.79
| Facility | | $2,818.38 | $9,120.11 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,344.23 / $11,481.54
| Facility | | $512.86 | $2,344.23 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Facility | 62 | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,202.26 / $5,495.41
| Facility | | $269.15 | $1,202.26 | $5,495.41 |