- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.20 / $2,402.50 / $7,506.50
| Facility | | $585.20 | $2,402.50 | $7,506.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,574.00 / $10,099.00 / $21,510.00
| Facility | | $4,574.00 | $10,099.00 | $21,510.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.42 / $550.42 / $842.00
| Facility | | $550.42 | $550.42 | $842.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $337.64 / $337.64 / $337.64
| Facility | 62 | $337.64 | $337.64 | $337.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $54.02 / $54.02 / $54.02
| Facility | AS | $54.02 | $54.02 | $54.02 |
- 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 |