- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,019.95 / $10,000.00
| Facility | | $707.95 | $3,019.95 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,589.25 / $22,387.21
| Facility | | $4,677.35 | $12,589.25 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,348.96 / $15,135.61
| Facility | | $512.86 | $1,348.96 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | 22 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Facility | 62 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.18 / $83.18 / $83.18
| Facility | AS | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,230.27 / $3,981.07
| Facility | | $269.15 | $1,230.27 | $3,981.07 |