- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $3,167.80 / $8,229.00
| Facility | | $2,747.00 | $3,167.80 | $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
- $2,937.42 / $4,031.75 / $4,650.92
| Facility | | $2,937.42 | $4,031.75 | $4,650.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,543.61 / $3,543.61 / $3,543.61
| Facility | | $3,543.61 | $3,543.61 | $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
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |