- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,700.00 / $2,177.98
| Facility | | $1,400.00 | $1,700.00 | $2,177.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,220.21 / $2,664.26 / $2,902.76
| Facility | | $2,220.21 | $2,664.26 | $2,902.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,565.08 / $2,565.08 / $2,565.08
| Facility | | $2,565.08 | $2,565.08 | $2,565.08 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,579.13 / $1,579.13 / $1,579.13
| Facility | 62 | $1,579.13 | $1,579.13 | $1,579.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $252.66 / $252.66 / $252.66
| Facility | AS | $252.66 | $252.66 | $252.66 |