- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,502.59 / $8,229.00
| Facility | | $860.00 | $2,502.59 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,212.00 / $9,592.68 / $21,957.82
| Facility | | $7,212.00 | $9,592.68 | $21,957.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,058.05 / $2,824.72 / $3,258.52
| Facility | | $2,058.05 | $2,824.72 | $3,258.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,107.19 / $2,478.02 / $2,478.02
| Facility | | $2,107.19 | $2,478.02 | $2,478.02 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,508.29 / $1,508.29 / $1,508.29
| Facility | 62 | $1,508.29 | $1,508.29 | $1,508.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $241.33 / $241.33 / $241.33
| Facility | AS | $241.33 | $241.33 | $241.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $4,298.00 / $30,001.00
| Facility | | $599.00 | $4,298.00 | $30,001.00 |