- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.96 / $1,400.00 / $2,600.00
| Facility | | $1,204.96 | $1,400.00 | $2,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.95 / $1,579.82 / $1,721.24
| Facility | | $1,372.95 | $1,579.82 | $1,721.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.67 / $1,470.67 / $1,470.67
| Facility | | $1,470.67 | $1,470.67 | $1,470.67 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $913.41 / $913.41 / $913.41
| Facility | 62 | $913.41 | $913.41 | $913.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $146.15 / $146.15 / $146.15
| Facility | AS | $146.15 | $146.15 | $146.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,530.66 / $7,530.66 / $24,471.27
| Facility | | $7,530.66 | $7,530.66 | $24,471.27 |