- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,814.82 / $9,894.00
| Facility | | $900.00 | $2,814.82 | $9,894.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,650.86 / $16,291.15 / $25,014.70
| Facility | | $8,650.86 | $16,291.15 | $25,014.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.94 / $8,779.84 / $8,779.84
| Facility | | $1,392.94 | $8,779.84 | $8,779.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,749.72
| Facility | | $488.00 | $675.00 | $1,749.72 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $1,127.00 / $5,780.00 / $12,805.00
| Facility | | $1,127.00 | $5,780.00 | $12,805.00 |