- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,749.77 / $6,348.00
| Facility | | $100.00 | $1,749.77 | $6,348.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.13 / $825.13 / $825.13
| Facility | | $825.13 | $825.13 | $825.13 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $506.10 / $506.10 / $506.10
| Facility | 62 | $506.10 | $506.10 | $506.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $80.98 / $80.98 / $80.98
| Facility | AS | $80.98 | $80.98 | $80.98 |
- 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 |