- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.57 / $1,400.00 / $3,050.00
| Facility | | $1,298.57 | $1,400.00 | $3,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.64 / $1,591.37 / $1,733.82
| Facility | | $1,388.64 | $1,591.37 | $1,733.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.82 / $1,486.82 / $1,486.82
| Facility | | $1,486.82 | $1,486.82 | $1,486.82 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $925.06 / $925.06 / $925.06
| Facility | 62 | $925.06 | $925.06 | $925.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $148.01 / $148.01 / $148.01
| Facility | AS | $148.01 | $148.01 | $148.01 |