- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,805.25 / $6,640.00 / $10,860.55
| Facility | | $1,805.25 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.78 / $1,977.54 / $4,435.00
| Facility | | $1,440.78 | $1,977.54 | $4,435.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,269.73 / $2,269.73 / $4,249.09
| Facility | 62 | $2,269.73 | $2,269.73 | $4,249.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $363.16 / $363.16 / $679.85
| Facility | AS | $363.16 | $363.16 | $679.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $6,416.00
| Facility | | $1,424.00 | $3,269.00 | $6,416.00 |