- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,933.00 / $8,104.00
| Facility | | $1,170.00 | $2,933.00 | $8,104.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.30 / $3,321.60 / $5,432.89
| Facility | | $882.30 | $3,321.60 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.72 / $998.80 / $2,022.00
| Facility | | $766.72 | $998.80 | $2,022.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,219.83 / $1,219.83 / $2,323.71
| Facility | 62 | $1,219.83 | $1,219.83 | $2,323.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $195.17 / $195.17 / $371.79
| Facility | AS | $195.17 | $195.17 | $371.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.00 / $1,535.00 / $2,326.00
| Facility | | $716.00 | $1,535.00 | $2,326.00 |