- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,419.19 / $8,965.00
| Facility | | $100.00 | $1,419.19 | $8,965.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.46 / $444.46 / $444.46
| Facility | | $444.46 | $444.46 | $444.46 |
- 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
- $7,448.00 / $7,448.00 / $7,448.00
| Facility | | $7,448.00 | $7,448.00 | $7,448.00 |