- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,304.00 / $6,972.00 / $10,546.00
| Facility | | $2,304.00 | $6,972.00 | $10,546.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,660.00 / $6,198.03 / $10,860.55
| Facility | | $1,660.00 | $6,198.03 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.68 / $2,190.53 / $8,285.00
| Facility | | $1,593.68 | $2,190.53 | $8,285.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,639.94 / $13,156.44 / $13,156.44
| Facility | 62 | $2,639.94 | $13,156.44 | $13,156.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $422.39 / $2,105.03 / $2,105.03
| Facility | AS | $422.39 | $2,105.03 | $2,105.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.00 / $7,088.00 / $11,396.00
| Facility | | $1,472.00 | $7,088.00 | $11,396.00 |