- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,600.00 / $2,610.42
| Facility | | $1,400.00 | $2,600.00 | $2,610.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,870.10 / $3,214.68 / $3,502.44
| Facility | | $2,870.10 | $3,214.68 | $3,502.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,066.37 / $3,066.37 / $3,066.37
| Facility | | $3,066.37 | $3,066.37 | $3,066.37 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,892.76 / $1,892.76 / $1,892.76
| Facility | 62 | $1,892.76 | $1,892.76 | $1,892.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $302.83 / $302.83 / $302.83
| Facility | AS | $302.83 | $302.83 | $302.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.11 / $2,080.11 / $2,080.11
| Facility | | $2,080.11 | $2,080.11 | $2,080.11 |