- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $3,683.00 / $7,500.00
| Facility | | $750.00 | $3,683.00 | $7,500.00 |
- 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
- $386.75 / $552.62 / $2,743.00
| Facility | | $386.75 | $552.62 | $2,743.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $583.51 / $1,112.64 / $1,112.64
| Facility | 62 | $583.51 | $1,112.64 | $1,112.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $93.36 / $178.02 / $178.02
| Facility | AS | $93.36 | $178.02 | $178.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.00 / $634.00 / $1,883.00
| Facility | | $139.00 | $634.00 | $1,883.00 |