- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.27 / $3,617.00 / $8,602.00
| Facility | | $1,065.27 | $3,617.00 | $8,602.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $19,435.71 / $19,435.71 / $19,435.71
| Facility | 62 | $19,435.71 | $19,435.71 | $19,435.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,557.00 / $8,269.50 / $13,642.28
| Facility | | $4,557.00 | $8,269.50 | $13,642.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.14 / $1,182.14 / $1,659.42
| Facility | | $1,182.14 | $1,182.14 | $1,659.42 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $735.39 / $735.39 / $735.39
| Facility | 62 | $735.39 | $735.39 | $735.39 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $117.66 / $117.66 / $117.66
| Facility | AS | $117.66 | $117.66 | $117.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |