- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.00 / $2,300.00 / $5,506.00
| Facility | | $570.00 | $2,300.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.68 / $1,233.59 / $2,017.71
| Facility | | $327.68 | $1,233.59 | $2,017.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.14 / $283.41 / $7,289.00
| Facility | | $204.14 | $283.41 | $7,289.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $342.53 / $342.53 / $650.92
| Facility | 62 | $342.53 | $342.53 | $650.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $54.80 / $54.80 / $104.15
| Facility | AS | $54.80 | $54.80 | $104.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.00 / $1,960.00 / $7,499.00
| Facility | | $1,203.00 | $1,960.00 | $7,499.00 |