- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $3,684.00 / $18,600.00
| Facility | | $1,346.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $2,914.94 / $5,991.35
| Facility | | $773.00 | $2,914.94 | $5,991.35 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $6,964.51 / $6,964.51 / $6,964.51
| Facility | 62 | $6,964.51 | $6,964.51 | $6,964.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,114.32 / $1,114.32 / $1,114.32
| Facility | AS | $1,114.32 | $1,114.32 | $1,114.32 |
- 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 |