- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.19 / $758.40 / $1,240.46
| Facility | | $206.19 | $758.40 | $1,240.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.78 / $450.76 / $4,199.00
| Facility | | $207.78 | $450.76 | $4,199.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $301.62 / $301.62 / $876.02
| Facility | 62 | $301.62 | $301.62 | $876.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $48.26 / $48.26 / $140.16
| Facility | AS | $48.26 | $48.26 | $140.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $6,416.00
| Facility | | $1,424.00 | $3,269.00 | $6,416.00 |