- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $2,303.00 / $7,602.00
| Facility | | $582.00 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $147.00 / $2,052.00
| Facility | | $108.00 | $147.00 | $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 / $5,631.08 / $5,756.38
| Facility | | $55.00 | $5,631.08 | $5,756.38 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $541.86 / $1,068.33 / $1,068.33
| Facility | 62 | $541.86 | $1,068.33 | $1,068.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.70 / $170.93 / $170.93
| Facility | AS | $86.70 | $170.93 | $170.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |