- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,630.27 / $10,232.93
| Facility | | $323.59 | $2,630.27 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $151.36 / $1,995.26
| Facility | | $100.00 | $151.36 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $512.86 / $794.33
| Facility | | $501.19 | $512.86 | $794.33 |
- 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
- $54.95 / $2,137.96 / $2,137.96
| Facility | | $54.95 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 62 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | AS | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,623.41 / $10,000.00
| Facility | | $1,548.82 | $5,623.41 | $10,000.00 |