- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,258.93 / $1,905.46
| Facility | | $562.34 | $1,258.93 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $16,595.87 / $22,908.68
| Facility | | $14,125.38 | $16,595.87 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Facility | 62 | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,248.07 / $8,317.64
| Facility | | $1,584.89 | $5,248.07 | $8,317.64 |