- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.00 / $2,260.00 / $5,506.00
| Facility | | $660.00 | $2,260.00 | $5,506.00 |
- 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
- $367.98 / $499.90 / $1,944.00
| Facility | | $367.98 | $499.90 | $1,944.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $583.51 / $583.51 / $1,112.64
| Facility | 62 | $583.51 | $583.51 | $1,112.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $93.36 / $93.36 / $178.02
| Facility | AS | $93.36 | $93.36 | $178.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,175.00
| Facility | | $704.00 | $1,535.00 | $2,175.00 |