- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.73 / $2,283.00 / $7,082.02
| Facility | | $309.73 | $2,283.00 | $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
- $510.15 / $765.00 / $978.92
| Facility | | $510.15 | $765.00 | $978.92 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $159.84 / $159.84 / $159.84
| Facility | 62 | $159.84 | $159.84 | $159.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $25.58 / $25.58 / $25.58
| Facility | AS | $25.58 | $25.58 | $25.58 |
- 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 |