- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $6,025.60 / $12,302.69
| Facility | | $1,047.13 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $1,122.02
| Facility | | $323.59 | $501.19 | $1,122.02 |
- 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
- $7,943.28 / $20,892.96 / $33,113.11
| Facility | | $7,943.28 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $10,000.00 / $15,848.93
| Facility | | $2,187.76 | $10,000.00 | $15,848.93 |