- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,626.70 / $6,098.00 / $10,255.42
| Facility | | $4,626.70 | $6,098.00 | $10,255.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,463.86 / $2,340.94 / $4,107.30
| Professional | | $1,463.86 | $2,340.94 | $4,107.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,435.11 / $3,836.85 / $31,554.43
| Facility | | $2,435.11 | $3,836.85 | $31,554.43 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $47,165.25 / $47,165.25 / $47,165.25
| Facility | 62 | $47,165.25 | $47,165.25 | $47,165.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $7,546.44 / $7,546.44 / $7,546.44
| Facility | AS | $7,546.44 | $7,546.44 | $7,546.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,931.00 / $4,202.28 / $26,367.49
| Facility | | $2,931.00 | $4,202.28 | $26,367.49 |
- 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 |