- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.25 / $2,444.79 / $7,387.64
| Facility | | $704.25 | $2,444.79 | $7,387.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,294.00 / $8,541.00 / $14,586.00
| Facility | | $3,294.00 | $8,541.00 | $14,586.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.13 / $842.50 / $877.69
| Facility | | $825.13 | $842.50 | $877.69 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $506.10 / $506.10 / $506.10
| Facility | 62 | $506.10 | $506.10 | $506.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $80.98 / $80.98 / $80.98
| Facility | AS | $80.98 | $80.98 | $80.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,576.00 / $17,069.00
| Facility | | $3,028.00 | $7,576.00 | $17,069.00 |