- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.13 / $2,085.00 / $7,506.50
| Facility | | $740.13 | $2,085.00 | $7,506.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,574.00 / $9,596.00 / $16,083.00
| Facility | | $4,574.00 | $9,596.00 | $16,083.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.56 / $866.56 / $868.52
| Facility | | $866.56 | $866.56 | $868.52 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $531.50 / $531.50 / $531.50
| Facility | 62 | $531.50 | $531.50 | $531.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.04 / $85.04 / $85.04
| Facility | AS | $85.04 | $85.04 | $85.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,221.00 / $3,685.00
| Facility | | $293.00 | $1,221.00 | $3,685.00 |