- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,920.43 / $20,847.32 / $32,402.74
| Facility | | $4,920.43 | $20,847.32 | $32,402.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.63 / $1,303.96 / $1,629.95
| Facility | | $1,086.63 | $1,303.96 | $1,629.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.01 / $1,260.01 / $1,260.01
| Facility | | $1,260.01 | $1,260.01 | $1,260.01 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $783.15 / $783.15 / $783.15
| Facility | 62 | $783.15 | $783.15 | $783.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.30 / $125.30 / $125.30
| Facility | AS | $125.30 | $125.30 | $125.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,964.72 / $26,864.88 / $29,588.48
| Facility | | $7,964.72 | $26,864.88 | $29,588.48 |