- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,890.45 / $7,943.28
| Facility | | $2,041.74 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,187.76 / $3,981.07
| Facility | | $831.76 | $2,187.76 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $6,025.60
| Facility | | $331.13 | $457.09 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $537.03 / $537.03 / $1,000.00
| Facility | 62 | $537.03 | $537.03 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.11 / $85.11 / $158.49
| Facility | AS | $85.11 | $85.11 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $5,623.41 / $8,317.64
| Facility | | $1,174.90 | $5,623.41 | $8,317.64 |