- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.80 / $2,408.60 / $8,229.00
| Facility | | $2,248.80 | $2,408.60 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.25 / $9,122.94 / $15,243.15
| Facility | | $5,049.25 | $9,122.94 | $15,243.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.91 / $3,020.85 / $3,484.77
| Facility | | $2,200.91 | $3,020.85 | $3,484.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.64 / $2,654.64 / $2,654.64
| Facility | | $2,654.64 | $2,654.64 | $2,654.64 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,628.99 / $1,628.99 / $1,628.99
| Facility | 62 | $1,628.99 | $1,628.99 | $1,628.99 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $260.64 / $260.64 / $260.64
| Facility | AS | $260.64 | $260.64 | $260.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |