- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $3,684.00 / $18,600.00
| Facility | | $1,346.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,701.16 / $12,172.15 / $19,381.03
| Facility | | $7,701.16 | $12,172.15 | $19,381.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,765.30 / $7,223.00
| Facility | | $773.00 | $1,765.30 | $7,223.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,618.02 / $3,618.02 / $3,618.02
| Facility | 62 | $3,618.02 | $3,618.02 | $3,618.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $578.88 / $578.88 / $578.88
| Facility | AS | $578.88 | $578.88 | $578.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |