- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.81 / $2,495.00 / $7,506.50
| Facility | | $511.81 | $2,495.00 | $7,506.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,385.00 / $4,314.00 / $9,729.00
| Facility | | $2,385.00 | $4,314.00 | $9,729.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.85 / $585.40 / $640.60
| Facility | | $535.85 | $585.40 | $640.60 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $250.26 / $250.26 / $250.26
| Facility | 62 | $250.26 | $250.26 | $250.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $40.04 / $40.04 / $40.04
| Facility | AS | $40.04 | $40.04 | $40.04 |
- 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 |