- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $3,804.70 / $16,001.11
| Facility | | $100.00 | $3,804.70 | $16,001.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,512.20 / $9,458.00 / $17,400.00
| Facility | | $8,512.20 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.01 / $5,257.46 / $5,441.47
| Facility | | $1,260.01 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $783.15 / $783.15 / $783.15
| Facility | 62 | $783.15 | $783.15 | $783.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.30 / $125.30 / $125.30
| Facility | AS | $125.30 | $125.30 | $125.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,399.00 / $12,399.00 / $12,399.00
| Facility | | $12,399.00 | $12,399.00 | $12,399.00 |