- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,515.78 / $7,838.38 / $8,644.27
| Facility | | $2,515.78 | $7,838.38 | $8,644.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,433.29 / $25,710.97 / $41,931.22
| Facility | | $10,433.29 | $25,710.97 | $41,931.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.72 / $1,749.72 / $1,749.72
| Facility | | $1,749.72 | $1,749.72 | $1,749.72 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,070.46 / $1,070.46 / $1,070.46
| Facility | 62 | $1,070.46 | $1,070.46 | $1,070.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.27 / $171.27 / $171.27
| Facility | AS | $171.27 | $171.27 | $171.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.23 / $1,749.72 / $2,303.83
| Facility | | $1,454.23 | $1,749.72 | $2,303.83 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,070.46 / $1,070.46 / $1,070.46
| Facility | 62 | $1,070.46 | $1,070.46 | $1,070.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.27 / $171.27 / $171.27
| Facility | AS | $171.27 | $171.27 | $171.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,002.00 / $15,131.00 / $16,269.00
| Facility | | $2,002.00 | $15,131.00 | $16,269.00 |