- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.59 / $2,351.57 / $6,220.50
| Facility | | $716.59 | $2,351.57 | $6,220.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,574.00 / $8,170.00 / $16,083.00
| Facility | | $4,574.00 | $8,170.00 | $16,083.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.77 / $858.77 / $858.77
| Facility | | $858.77 | $858.77 | $858.77 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $526.61 / $526.61 / $526.61
| Facility | 62 | $526.61 | $526.61 | $526.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.26 / $84.26 / $84.26
| Facility | AS | $84.26 | $84.26 | $84.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,221.00 / $2,733.00
| Facility | | $293.00 | $1,221.00 | $2,733.00 |