- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $3,235.94 / $10,000.00
| Facility | | $691.83 | $3,235.94 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $12,589.25 / $24,547.09
| Facility | | $4,265.80 | $12,589.25 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $933.25 / $2,884.03
| Facility | | $34.67 | $933.25 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | 62 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Facility | AS | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,202.26 / $3,630.78
| Facility | | $269.15 | $1,202.26 | $3,630.78 |