- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,921.70 / $6,298.62 / $11,100.08
| Facility | | $4,921.70 | $6,298.62 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,576.76 / $2,437.96 / $6,895.99
| Professional | | $1,576.76 | $2,437.96 | $6,895.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,141.36 / $4,279.02 / $22,077.44
| Facility | | $2,141.36 | $4,279.02 | $22,077.44 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $30,473.31 / $30,473.31 / $30,473.31
| Facility | 62 | $30,473.31 | $30,473.31 | $30,473.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $4,875.72 / $4,875.72 / $4,875.72
| Facility | AS | $4,875.72 | $4,875.72 | $4,875.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,704.58 / $4,508.35 / $18,138.04
| Facility | | $3,704.58 | $4,508.35 | $18,138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |