- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.00 / $2,532.77 / $8,229.00
| Facility | | $896.00 | $2,532.77 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,584.00 / $10,990.10 / $30,856.09
| Facility | | $8,584.00 | $10,990.10 | $30,856.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,108.33 / $3,106.45 / $3,583.51
| Facility | | $2,108.33 | $3,106.45 | $3,583.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,733.97 / $2,733.97 / $2,733.97
| Facility | | $2,733.97 | $2,733.97 | $2,733.97 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,688.18 / $1,688.18 / $1,688.18
| Facility | 62 | $1,688.18 | $1,688.18 | $1,688.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $270.11 / $270.11 / $270.11
| Facility | AS | $270.11 | $270.11 | $270.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |