- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $7,562.14
| Facility | | $1,671.00 | $3,617.00 | $7,562.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.64 / $1,335.71 / $4,276.00
| Facility | | $987.64 | $1,335.71 | $4,276.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,575.61 / $2,988.85 / $2,988.85
| Facility | 62 | $1,575.61 | $2,988.85 | $2,988.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $252.10 / $478.22 / $478.22
| Facility | AS | $252.10 | $478.22 | $478.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $14,572.00
| Facility | | $1,424.00 | $3,269.00 | $14,572.00 |