- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,212.00 / $4,630.76
| Facility | | $900.00 | $3,212.00 | $4,630.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $2,805.63 / $2,805.63
| Facility | | $40.00 | $2,805.63 | $2,805.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $3,543.61
| Facility | | $488.00 | $675.00 | $3,543.61 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,171.67 / $2,171.67 / $2,171.67
| Facility | 62 | $2,171.67 | $2,171.67 | $2,171.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $347.47 / $347.47 / $347.47
| Facility | AS | $347.47 | $347.47 | $347.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,261.00 / $7,168.00
| Facility | | $385.00 | $1,261.00 | $7,168.00 |