- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $618.64 / $3,617.00 / $6,060.00
| Facility | | $618.64 | $3,617.00 | $6,060.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.30 / $3,321.60 / $5,432.89
| Facility | | $882.30 | $3,321.60 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.75 / $427.64 / $8,405.00
| Facility | | $304.75 | $427.64 | $8,405.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $486.75 / $486.75 / $919.65
| Facility | 62 | $486.75 | $486.75 | $919.65 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.88 / $77.88 / $147.13
| Facility | AS | $77.88 | $77.88 | $147.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,341.00 / $22,158.00
| Facility | | $5,255.00 | $7,341.00 | $22,158.00 |