- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.66 / $2,735.56 / $7,838.38
| Facility | | $883.66 | $2,735.56 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.50 / $2,873.00 / $8,514.00
| Facility | | $629.50 | $2,873.00 | $8,514.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.06 / $928.06 / $928.06
| Facility | | $928.06 | $928.06 | $928.06 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $569.25 / $569.25 / $569.25
| Facility | 62 | $569.25 | $569.25 | $569.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $91.08 / $91.08 / $91.08
| Facility | AS | $91.08 | $91.08 | $91.08 |
- 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 |