- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.28 / $2,124.00 / $7,542.00
| Facility | | $507.28 | $2,124.00 | $7,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,464.00 / $7,631.00 / $14,670.00
| Facility | | $4,464.00 | $7,631.00 | $14,670.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.55 / $556.55 / $842.50
| Facility | | $556.55 | $556.55 | $842.50 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $272.63 / $272.63 / $272.63
| Facility | 62 | $272.63 | $272.63 | $272.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.62 / $43.62 / $43.62
| Facility | AS | $43.62 | $43.62 | $43.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,221.00 / $2,883.00
| Facility | | $293.00 | $1,221.00 | $2,883.00 |