- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.00 / $2,114.00 / $7,960.15
| Facility | | $570.00 | $2,114.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.40 / $3,300.84 / $5,432.89
| Facility | | $830.40 | $3,300.84 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.64 / $937.00 / $1,977.00
| Facility | | $715.64 | $937.00 | $1,977.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,139.24 / $1,139.24 / $2,168.54
| Facility | 62 | $1,139.24 | $1,139.24 | $2,168.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.28 / $182.28 / $346.97
| Facility | AS | $182.28 | $182.28 | $346.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.00 / $1,535.00 / $2,175.00
| Facility | | $716.00 | $1,535.00 | $2,175.00 |