- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $2,444.00 / $7,500.00
| Facility | | $750.00 | $2,444.00 | $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
- $759.88 / $1,075.45 / $11,315.00
| Facility | | $759.88 | $1,075.45 | $11,315.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,081.98 / $2,062.56 / $2,062.56
| Facility | 62 | $1,081.98 | $2,062.56 | $2,062.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.12 / $330.01 / $330.01
| Facility | AS | $173.12 | $330.01 | $330.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,139.00
| Facility | | $1,851.00 | $7,074.00 | $14,139.00 |