- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $9,859.00
| Facility | | $100.00 | $100.00 | $9,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.63 / $5,257.46 / $5,441.47
| Facility | | $260.63 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $159.84 / $159.84 / $159.84
| Facility | 62 | $159.84 | $159.84 | $159.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $25.58 / $25.58 / $25.58
| Facility | AS | $25.58 | $25.58 | $25.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,448.00 / $7,448.00 / $7,448.00
| Facility | | $7,448.00 | $7,448.00 | $7,448.00 |