- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $4,396.00 / $7,960.15
| Facility | | $2,747.00 | $4,396.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,114.84 / $9,122.94 / $14,433.40
| Facility | | $4,114.84 | $9,122.94 | $14,433.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $3,543.61
| Facility | | $680.00 | $870.49 | $3,543.61 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,171.67 / $2,171.67 / $2,171.67
| Facility | 62 | $2,171.67 | $2,171.67 | $2,171.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $347.47 / $347.47 / $347.47
| Facility | AS | $347.47 | $347.47 | $347.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |