- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $3,287.15 / $4,846.00
| Facility | | $2,318.00 | $3,287.15 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,794.08 / $3,561.08 / $4,108.93
| Facility | | $2,794.08 | $3,561.08 | $4,108.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $3,543.61
| Facility | | $761.00 | $761.00 | $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
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |