- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,437.00 / $6,329.00
| Facility | | $1,671.00 | $3,437.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.08 / $1,770.00 / $4,276.00
| Facility | | $1,329.08 | $1,770.00 | $4,276.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,107.56 / $3,920.79 / $3,920.79
| Facility | 62 | $2,107.56 | $3,920.79 | $3,920.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $337.21 / $627.33 / $627.33
| Facility | AS | $337.21 | $627.33 | $627.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.00 / $2,572.00 / $6,416.00
| Facility | | $1,360.00 | $2,572.00 | $6,416.00 |