- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $2,258.00 / $7,602.00
| Facility | | $575.00 | $2,258.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $148.00 / $2,052.00
| Facility | | $108.00 | $148.00 | $2,052.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,175.25 / $1,720.97
| Facility | | $55.00 | $1,175.25 | $1,720.97 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $545.95 / $1,075.60 / $1,075.60
| Facility | 62 | $545.95 | $1,075.60 | $1,075.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.35 / $172.10 / $172.10
| Facility | AS | $87.35 | $172.10 | $172.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |