- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,974.46 / $9,859.00
| Facility | | $100.00 | $2,974.46 | $9,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,550.00 / $51,903.94 / $90,489.02
| Facility | | $26,550.00 | $51,903.94 | $90,489.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.82 / $1,486.82 / $1,486.82
| Facility | | $1,486.82 | $1,486.82 | $1,486.82 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $925.06 / $925.06 / $925.06
| Facility | 62 | $925.06 | $925.06 | $925.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $148.01 / $148.01 / $148.01
| Facility | AS | $148.01 | $148.01 | $148.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,629.00 / $12,629.00 / $12,629.00
| Facility | | $12,629.00 | $12,629.00 | $12,629.00 |