- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $4,570.88 / $11,481.54
| Facility | | $389.05 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,244.36 / $14,791.08
| Facility | | $2,691.53 | $7,244.36 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $562.34 / $1,584.89
| Facility | | $204.17 | $562.34 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Facility | 62 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $34.67 / $34.67 / $34.67
| Facility | AS | $34.67 | $34.67 | $34.67 |
- 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 |