- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.36 / $2,155.89 / $7,082.02
| Facility | | $362.36 | $2,155.89 | $7,082.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,616.00 / $7,875.00 / $11,253.00
| Facility | | $2,616.00 | $7,875.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.13 / $814.60 / $1,101.69
| Facility | | $574.13 | $814.60 | $1,101.69 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $179.89 / $179.89 / $179.89
| Facility | 62 | $179.89 | $179.89 | $179.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $28.78 / $28.78 / $28.78
| Facility | AS | $28.78 | $28.78 | $28.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,218.00 / $3,239.00
| Facility | | $293.00 | $1,218.00 | $3,239.00 |