- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.00 / $3,131.00 / $8,000.00
| Facility | | $818.00 | $3,131.00 | $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
- $302.44 / $533.74 / $1,210.30
| Facility | | $302.44 | $533.74 | $1,210.30 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $541.86 / $541.86 / $1,025.63
| Facility | 62 | $541.86 | $541.86 | $1,025.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.70 / $86.70 / $164.10
| Facility | AS | $86.70 | $86.70 | $164.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $875.00 / $3,233.00
| Facility | | $245.00 | $875.00 | $3,233.00 |