- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,623.41 / $10,000.00
| Facility | | $2,511.89 | $5,623.41 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,370.32 / $10,471.29
| Facility | | $2,238.72 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,570.88 / $9,772.37
| Facility | | $2,818.38 | $4,570.88 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $5,370.32 / $10,000.00 / $10,000.00
| Facility | 62 | $5,370.32 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $851.14 / $1,584.89 / $1,584.89
| Facility | AS | $851.14 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,818.38 / $10,964.78
| Facility | | $1,230.27 | $2,818.38 | $10,964.78 |