- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $3,503.73 / $7,602.00
| Facility | | $1,821.00 | $3,503.73 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.00 / $2,272.00 / $4,372.00
| Facility | | $1,270.00 | $2,272.00 | $4,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $11,592.96 / $11,858.00
| Facility | | $55.00 | $11,592.96 | $11,858.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,031.93 / $3,884.04 / $3,884.04
| Facility | 62 | $2,031.93 | $3,884.04 | $3,884.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $325.11 / $621.45 / $621.45
| Facility | AS | $325.11 | $621.45 | $621.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,665.00 / $4,918.00
| Facility | | $1,200.00 | $2,665.00 | $4,918.00 |