- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.65 / $2,747.00 / $8,229.00
| Facility | | $371.65 | $2,747.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,574.00 / $8,541.00 / $16,838.00
| Facility | | $4,574.00 | $8,541.00 | $16,838.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.25 / $508.25 / $842.50
| Facility | | $508.25 | $508.25 | $842.50 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $225.79 / $225.79 / $225.79
| Facility | 62 | $225.79 | $225.79 | $225.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $36.13 / $36.13 / $36.13
| Facility | AS | $36.13 | $36.13 | $36.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,576.00 / $14,428.00
| Facility | | $3,028.00 | $7,576.00 | $14,428.00 |