- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,535.29 / $3,050.00
| Facility | | $1,400.00 | $1,535.29 | $3,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,494.12 / $1,792.94 / $2,241.17
| Facility | | $1,494.12 | $1,792.94 | $2,241.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,738.20 / $1,738.20 / $1,738.20
| Facility | | $1,738.20 | $1,738.20 | $1,738.20 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,073.02 / $1,073.02 / $1,073.02
| Facility | 62 | $1,073.02 | $1,073.02 | $1,073.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.68 / $171.68 / $171.68
| Facility | AS | $171.68 | $171.68 | $171.68 |