- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $7,838.38
| Facility | | $1,000.00 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,013.89 / $4,013.89 / $4,013.89
| Facility | | $4,013.89 | $4,013.89 | $4,013.89 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,448.96 / $2,448.96 / $2,448.96
| Facility | 62 | $2,448.96 | $2,448.96 | $2,448.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $391.83 / $391.83 / $391.83
| Facility | AS | $391.83 | $391.83 | $391.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,218.76 / $3,815.58 / $5,342.20
| Facility | | $3,218.76 | $3,815.58 | $5,342.20 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,448.96 / $2,448.96 / $2,448.96
| Facility | 62 | $2,448.96 | $2,448.96 | $2,448.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $391.83 / $391.83 / $391.83
| Facility | AS | $391.83 | $391.83 | $391.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $4,616.00 / $17,636.00
| Facility | | $755.00 | $4,616.00 | $17,636.00 |