- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.00 / $2,667.61 / $7,702.00
| Facility | | $1,032.00 | $2,667.61 | $7,702.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,755.00 / $8,584.00 / $11,253.00
| Facility | | $4,755.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,678.32 / $2,265.73 / $2,769.23
| Facility | | $1,678.32 | $2,265.73 | $2,769.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,059.71 / $2,059.71 / $2,059.71
| Facility | | $2,059.71 | $2,059.71 | $2,059.71 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,274.33 / $1,274.33 / $1,274.33
| Facility | 62 | $1,274.33 | $1,274.33 | $1,274.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $203.90 / $203.90 / $203.90
| Facility | AS | $203.90 | $203.90 | $203.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.00 / $6,378.00 / $18,870.00
| Facility | | $1,322.00 | $6,378.00 | $18,870.00 |