- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,818.38 / $8,511.38
| Facility | | $338.84 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,715.19 / $11,220.18
| Facility | | $6,606.93 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $371.54 / $524.81
| Facility | | $302.00 | $371.54 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $602.56 / $602.56
| Facility | | $34.67 | $602.56 | $602.56 |
- 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
- $724.44 / $2,511.89 / $10,000.00
| Facility | | $724.44 | $2,511.89 | $10,000.00 |