- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $4,570.88 / $11,748.98
| Facility | | $524.81 | $4,570.88 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,606.93 / $13,803.84
| Facility | | $2,818.38 | $6,606.93 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $2,398.83
| Facility | | $398.11 | $602.56 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | 62 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | AS | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,025.60 / $15,135.61
| Facility | | $1,380.38 | $6,025.60 | $15,135.61 |