- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,288.56 / $3,940.00 / $7,602.00
| Facility | | $2,288.56 | $3,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.00 / $2,326.00 / $4,372.00
| Facility | | $1,270.00 | $2,326.00 | $4,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $30,280.80 / $30,932.44
| Facility | | $55.00 | $30,280.80 | $30,932.44 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,766.27 / $7,386.49 / $7,386.49
| Facility | 62 | $3,766.27 | $7,386.49 | $7,386.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $602.60 / $1,181.83 / $1,181.83
| Facility | AS | $602.60 | $1,181.83 | $1,181.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,536.00 / $4,918.00
| Facility | | $1,200.00 | $2,536.00 | $4,918.00 |