- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,328.29 / $3,643.08 / $8,074.63
| Facility | | $1,328.29 | $3,643.08 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,195.00 / $10,577.77 / $19,959.86
| Facility | | $5,195.00 | $10,577.77 | $19,959.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,453.49 / $1,453.49 / $1,999.09
| Facility | | $1,453.49 | $1,453.49 | $1,999.09 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $885.91 / $885.91 / $885.91
| Facility | 62 | $885.91 | $885.91 | $885.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $141.75 / $141.75 / $141.75
| Facility | AS | $141.75 | $141.75 | $141.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |