- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,409.65 / $3,760.27
| Facility | | $1,400.00 | $2,409.65 | $3,760.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,546.17 / $2,912.05 / $3,172.73
| Facility | | $2,546.17 | $2,912.05 | $3,172.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,733.97 / $2,733.97 / $2,733.97
| Facility | | $2,733.97 | $2,733.97 | $2,733.97 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,688.18 / $1,688.18 / $1,688.18
| Facility | 62 | $1,688.18 | $1,688.18 | $1,688.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $270.11 / $270.11 / $270.11
| Facility | AS | $270.11 | $270.11 | $270.11 |