- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.00 / $2,640.00 / $5,506.00
| Facility | | $1,162.00 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.30 / $3,321.60 / $5,432.89
| Facility | | $882.30 | $3,321.60 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.41 / $460.37 / $1,944.00
| Facility | | $338.41 | $460.37 | $1,944.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $541.99 / $541.99 / $1,020.88
| Facility | 62 | $541.99 | $541.99 | $1,020.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.72 / $86.72 / $163.34
| Facility | AS | $86.72 | $86.72 | $163.34 |
- 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 |