- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,637.00 / $4,200.00 / $21,908.47
| Facility | | $1,637.00 | $4,200.00 | $21,908.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,663.51 / $16,643.25 / $32,126.95
| Facility | | $10,663.51 | $16,643.25 | $32,126.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $908.00 / $21,022.00
| Facility | | $400.00 | $908.00 | $21,022.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,070.46 / $1,070.46 / $1,070.46
| Facility | 62 | $1,070.46 | $1,070.46 | $1,070.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.27 / $171.27 / $171.27
| Facility | AS | $171.27 | $171.27 | $171.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,690.04 / $2,674.39 / $8,147.35
| Professional | | $1,690.04 | $2,674.39 | $8,147.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $6,920.00 / $16,667.00
| Facility | | $1,400.00 | $6,920.00 | $16,667.00 |