- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.86 / $2,678.00 / $7,602.00
| Facility | | $394.86 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $150.00 / $6,051.00
| Facility | | $108.00 | $150.00 | $6,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,401.63 / $1,401.63
| Facility | | $55.00 | $1,401.63 | $1,401.63 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $301.62 / $876.02 / $876.02
| Facility | 62 | $301.62 | $876.02 | $876.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $48.26 / $140.16 / $140.16
| Facility | AS | $48.26 | $140.16 | $140.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,536.00 / $4,918.00
| Facility | | $1,233.00 | $2,536.00 | $4,918.00 |