- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,890.45 / $7,943.28
| Facility | | $2,041.74 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,691.53 / $3,981.07
| Facility | | $831.76 | $2,691.53 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $389.05 / $4,365.16
| Facility | | $218.78 | $389.05 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $407.38 / $758.58 / $758.58
| Facility | 52 | $407.38 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $316.23 / $602.56 / $602.56
| Facility | 62 | $316.23 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $51.29 / $95.50 / $95.50
| Facility | AS | $51.29 | $95.50 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,290.87 / $5,495.41
| Facility | | $1,348.96 | $2,290.87 | $5,495.41 |