- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,640.00 / $5,506.00
| Facility | | $1,170.00 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.30 / $3,321.60 / $5,432.89
| Facility | | $882.30 | $3,321.60 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.67 / $465.39 / $1,650.07
| Facility | | $341.67 | $465.39 | $1,650.07 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $545.95 / $545.95 / $1,031.29
| Facility | 62 | $545.95 | $545.95 | $1,031.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.35 / $87.35 / $165.01
| Facility | AS | $87.35 | $87.35 | $165.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.00 / $1,535.00 / $2,175.00
| Facility | | $716.00 | $1,535.00 | $2,175.00 |