- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,311.00 / $3,065.64 / $10,234.00
| Facility | | $2,311.00 | $3,065.64 | $10,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,423.00 / $5,616.00
| Facility | | $1,375.00 | $2,423.00 | $5,616.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $25,959.20 / $26,715.04
| Facility | | $55.00 | $25,959.20 | $26,715.04 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,208.19 / $4,286.25 / $4,286.25
| Facility | 62 | $2,208.19 | $4,286.25 | $4,286.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $353.31 / $685.80 / $685.80
| Facility | AS | $353.31 | $685.80 | $685.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |