- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.16 / $2,647.00 / $7,572.00
| Facility | | $552.16 | $2,647.00 | $7,572.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.23 / $3,713.29 / $11,469.57
| Facility | | $580.23 | $3,713.29 | $11,469.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.15 / $458.15 / $632.00
| Facility | | $458.15 | $458.15 | $632.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $250.96 / $250.96 / $250.96
| Facility | 62 | $250.96 | $250.96 | $250.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $40.15 / $40.15 / $40.15
| Facility | AS | $40.15 | $40.15 | $40.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,158.00 / $2,733.00
| Facility | | $293.00 | $1,158.00 | $2,733.00 |