- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.30 / $4,413.20 / $12,530.46
| Facility | | $1,404.30 | $4,413.20 | $12,530.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,276.00 / $6,764.00 / $12,048.00
| Facility | | $3,276.00 | $6,764.00 | $12,048.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,422.45 / $19,913.50 / $25,000.00
| Facility | | $9,422.45 | $19,913.50 | $25,000.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,710.70 / $11,796.97 / $11,796.97
| Facility | 62 | $1,710.70 | $11,796.97 | $11,796.97 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $273.70 / $1,887.52 / $1,887.52
| Facility | AS | $273.70 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,222.00 / $12,407.00
| Facility | | $4,098.00 | $8,222.00 | $12,407.00 |