- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $4,897.79 / $5,370.32
| Facility | | $371.54 | $4,897.79 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,125.38 / $19,054.61
| Facility | | $6,456.54 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $338.84 / $389.05
| Facility | | $331.13 | $338.84 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $758.58
| Facility | | $602.56 | $602.56 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | 62 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | AS | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,000.00 / $15,848.93
| Facility | | $4,265.80 | $10,000.00 | $15,848.93 |