- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.00 / $2,832.00 / $8,000.00
| Facility | | $818.00 | $2,832.00 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.42 / $3,832.00 / $9,569.00
| Facility | | $1,386.42 | $3,832.00 | $9,569.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.44 / $541.49 / $1,066.51
| Facility | | $304.44 | $541.49 | $1,066.51 |
- 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
- $245.00 / $815.00 / $1,351.00
| Facility | | $245.00 | $815.00 | $1,351.00 |