- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,917.53 / $6,917.53 / $21,003.84
| Facility | | $6,917.53 | $6,917.53 | $21,003.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.00 / $699.00 / $1,749.72
| Facility | | $699.00 | $699.00 | $1,749.72 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,070.46 / $1,070.46 / $1,070.46
| Facility | 62 | $1,070.46 | $1,070.46 | $1,070.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.27 / $171.27 / $171.27
| Facility | AS | $171.27 | $171.27 | $171.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,917.53 / $11,794.07 / $27,985.64
| Facility | | $6,917.53 | $11,794.07 | $27,985.64 |