- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,747.00 / $8,229.00
| Facility | | $860.00 | $2,747.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,755.00 / $8,584.00 / $11,253.00
| Facility | | $4,755.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,288.17 / $3,121.62 / $3,601.01
| Facility | | $2,288.17 | $3,121.62 | $3,601.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,745.68 / $2,745.68 / $3,335.02
| Facility | | $2,745.68 | $2,745.68 | $3,335.02 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,669.77 / $1,669.77 / $1,669.77
| Facility | 62 | $1,669.77 | $1,669.77 | $1,669.77 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $267.16 / $267.16 / $267.16
| Facility | AS | $267.16 | $267.16 | $267.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $4,298.00 / $30,001.00
| Facility | | $599.00 | $4,298.00 | $30,001.00 |