- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $5,946.00 / $18,600.00
| Facility | | $1,456.00 | $5,946.00 | $18,600.00 |
- 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
- $22,628.58 / $22,628.58 / $22,628.58
| Facility | | $22,628.58 | $22,628.58 | $22,628.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.59 / $2,282.34 / $14,063.00
| Facility | | $1,615.59 | $2,282.34 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,441.19 / $47,165.25 / $47,165.25
| Facility | 62 | $2,441.19 | $47,165.25 | $47,165.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $390.59 / $7,546.44 / $7,546.44
| Facility | AS | $390.59 | $7,546.44 | $7,546.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,587.03
| Facility | | $1,851.00 | $7,074.00 | $14,587.03 |