- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $4,928.00 / $16,400.00
| Facility | | $1,392.00 | $4,928.00 | $16,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,444.76 / $15,084.81 / $23,838.74
| Facility | | $9,444.76 | $15,084.81 | $23,838.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,620.26 / $14,620.26 / $14,620.26
| Facility | | $14,620.26 | $14,620.26 | $14,620.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.40 / $2,490.66 / $14,587.03
| Facility | | $1,732.40 | $2,490.66 | $14,587.03 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,591.90 / $30,473.31 / $30,473.31
| Facility | 62 | $2,591.90 | $30,473.31 | $30,473.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $414.70 / $4,875.72 / $4,875.72
| Facility | AS | $414.70 | $4,875.72 | $4,875.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,307.00 / $14,139.00
| Facility | | $1,851.00 | $7,307.00 | $14,139.00 |