- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,472.64 / $5,251.70
| Facility | | $1,400.00 | $2,472.64 | $5,251.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,545.40 / $1,854.48 / $2,318.10
| Facility | | $1,545.40 | $1,854.48 | $2,318.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,799.47 / $1,799.47 / $1,799.47
| Facility | | $1,799.47 | $1,799.47 | $1,799.47 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,113.57 / $1,113.57 / $1,113.57
| Facility | 62 | $1,113.57 | $1,113.57 | $1,113.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $178.17 / $178.17 / $178.17
| Facility | AS | $178.17 | $178.17 | $178.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,433.46 / $22,801.57 / $84,077.69
| Facility | | $19,433.46 | $22,801.57 | $84,077.69 |