- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,960.79 / $29,500.96 / $29,500.96
| Facility | | $1,960.79 | $29,500.96 | $29,500.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,838.89 / $2,103.79 / $2,292.12
| Facility | | $1,838.89 | $2,103.79 | $2,292.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,971.38 / $1,971.38 / $1,971.38
| Facility | | $1,971.38 | $1,971.38 | $1,971.38 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,205.60 / $1,205.60 / $1,205.60
| Facility | 62 | $1,205.60 | $1,205.60 | $1,205.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $192.90 / $192.90 / $192.90
| Facility | AS | $192.90 | $192.90 | $192.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,825.14 / $27,457.21 / $53,015.20
| Facility | | $11,825.14 | $27,457.21 | $53,015.20 |