- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $3,909.00 / $18,600.00
| Facility | | $1,346.00 | $3,909.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $5,415.32 / $7,691.68
| Facility | | $498.00 | $5,415.32 | $7,691.68 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $13,549.59 / $13,549.59 / $13,549.59
| Facility | 62 | $13,549.59 | $13,549.59 | $13,549.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,167.94 / $2,167.94 / $2,167.94
| Facility | AS | $2,167.94 | $2,167.94 | $2,167.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |