- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,630.27 / $6,760.83
| Facility | | $1,288.25 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,187.76 / $6,309.57
| Facility | | $346.74 | $2,187.76 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | 62 | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | AS | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |