- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $4,833.00 / $16,400.00
| Facility | | $1,300.00 | $4,833.00 | $16,400.00 |
- 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
- $1,351.90 / $1,822.46 / $16,686.66
| Facility | | $1,351.90 | $1,822.46 | $16,686.66 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,007.47 / $3,781.71 / $3,781.71
| Facility | 62 | $2,007.47 | $3,781.71 | $3,781.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $321.20 / $605.07 / $605.07
| Facility | AS | $321.20 | $605.07 | $605.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,228.00 / $10,642.00 / $20,423.23
| Facility | | $3,228.00 | $10,642.00 | $20,423.23 |