- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,684.00 / $18,600.00
| Facility | | $1,000.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.53 / $501.98 / $6,334.00
| Facility | | $346.53 | $501.98 | $6,334.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $992.48 / $992.48 / $992.48
| Facility | 62 | $992.48 | $992.48 | $992.48 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.80 / $158.80 / $158.80
| Facility | AS | $158.80 | $158.80 | $158.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,910.00 / $9,232.95
| Facility | | $1,481.00 | $5,910.00 | $9,232.95 |