- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.00 / $4,856.00 / $14,100.00
| Facility | | $1,474.00 | $4,856.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,444.76 / $15,004.39 / $23,706.76
| Facility | | $9,444.76 | $15,004.39 | $23,706.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $900.00 / $900.00
| Facility | | $900.00 | $900.00 | $900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $2,083.04 / $11,495.55
| Facility | | $1,500.00 | $2,083.04 | $11,495.55 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,355.23 / $4,376.83 / $4,376.83
| Facility | 62 | $2,355.23 | $4,376.83 | $4,376.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $376.84 / $700.29 / $700.29
| Facility | AS | $376.84 | $700.29 | $700.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,139.00
| Facility | | $1,851.00 | $7,074.00 | $14,139.00 |