- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,389.42 / $3,643.18
| Facility | | $1,400.00 | $2,389.42 | $3,643.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,476.02 / $2,821.38 / $3,073.94
| Facility | | $2,476.02 | $2,821.38 | $3,073.94 |
- 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 |