- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.44 / $546.21 / $1,060.56
| Professional | | $333.44 | $546.21 | $1,060.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.87 / $847.90 / $1,582.70
| Facility | | $536.87 | $847.90 | $1,582.70 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,025.63 / $1,025.63 / $1,025.63
| Facility | 62 | $1,025.63 | $1,025.63 | $1,025.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $164.10 / $164.10 / $164.10
| Facility | AS | $164.10 | $164.10 | $164.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.27 / $799.20 / $1,036.53
| Facility | | $625.27 | $799.20 | $1,036.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,640.00 / $2,126.00
| Facility | | $1,204.00 | $1,640.00 | $2,126.00 |