- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $4,466.84 / $11,220.18
| Facility | | $346.74 | $4,466.84 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,511.38 / $16,982.44
| Facility | | $3,311.31 | $8,511.38 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $549.54 / $1,698.24
| Facility | | $213.80 | $549.54 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Facility | 52 | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $223.87 / $223.87 / $223.87
| Facility | 62 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $36.31 / $36.31 / $36.31
| Facility | AS | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |