- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $3,742.00 / $18,600.00
| Facility | | $1,346.00 | $3,742.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $2,222.42 / $6,155.68
| Facility | | $498.00 | $2,222.42 | $6,155.68 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,716.47 / $4,716.47 / $4,716.47
| Facility | 62 | $4,716.47 | $4,716.47 | $4,716.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $754.64 / $754.64 / $754.64
| Facility | AS | $754.64 | $754.64 | $754.64 |
- 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 |