- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,445.44 / $6,456.54
| Facility | | $602.56 | $1,445.44 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $22,908.68
| Facility | | $8,912.51 | $13,803.84 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,949.84 / $11,481.54
| Facility | | $758.58 | $1,949.84 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,071.52 / $2,041.74 / $2,041.74
| Facility | 62 | $1,071.52 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.78 / $331.13 / $331.13
| Facility | AS | $173.78 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,244.36 / $14,125.38
| Facility | | $1,949.84 | $7,244.36 | $14,125.38 |