- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,104.38 / $28,560.96 / $46,044.96
| Facility | | $12,104.38 | $28,560.96 | $46,044.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,630.96 / $1,865.18 / $2,032.14
| Facility | | $1,630.96 | $1,865.18 | $2,032.14 |
- 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
- $20,577.81 / $26,349.56 / $49,068.54
| Facility | | $20,577.81 | $26,349.56 | $49,068.54 |