- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.46 / $1,821.00 / $6,681.00
| Facility | | $176.46 | $1,821.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.00 / $147.00 / $623.00
| Facility | | $101.00 | $147.00 | $623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,990.54 / $3,569.02 / $5,000.00
| Facility | | $2,990.54 | $3,569.02 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $342.53 / $676.58 / $676.58
| Facility | 62 | $342.53 | $676.58 | $676.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $54.80 / $108.25 / $108.25
| Facility | AS | $54.80 | $108.25 | $108.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,791.00
| Facility | | $294.00 | $808.00 | $2,791.00 |