- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,549.93 / $15,488.17
| Facility | | $4,570.88 | $9,549.93 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $19,952.62
| Facility | | $7,762.47 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $13,489.63
| Facility | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,754.23 / $21,379.62
| Facility | | $1,479.11 | $2,754.23 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,570.40 / $30,199.52 / $30,199.52
| Facility | 62 | $2,570.40 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $416.87 / $4,897.79 / $4,897.79
| Facility | AS | $416.87 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,715.35 / $5,248.07
| Professional | | $3,090.30 | $3,715.35 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $13,489.63
| Facility | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,772.37 / $16,982.44
| Facility | | $7,079.46 | $9,772.37 | $16,982.44 |