- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $4,470.00 / $8,000.00
| Facility | | $1,760.00 | $4,470.00 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,517.00 / $10,778.96
| Facility | | $2,224.00 | $4,517.00 | $10,778.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,668.24 / $2,680.00 / $6,575.46
| Facility | | $1,668.24 | $2,680.00 | $6,575.46 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,595.36 / $3,595.36 / $6,434.68
| Facility | 62 | $3,595.36 | $3,595.36 | $6,434.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $575.26 / $575.26 / $1,029.55
| Facility | AS | $575.26 | $575.26 | $1,029.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,874.00 / $5,813.00
| Facility | | $1,644.00 | $2,874.00 | $5,813.00 |