- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $6,098.00 / $10,255.42
| Facility | | $5,091.00 | $6,098.00 | $10,255.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,678.32 / $2,603.48 / $6,856.02
| Professional | | $1,678.32 | $2,603.48 | $6,856.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,213.48 / $4,466.14 / $28,675.35
| Facility | | $2,213.48 | $4,466.14 | $28,675.35 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $5,209.43 / $5,209.43 / $5,209.43
| Facility | 62 | $5,209.43 | $5,209.43 | $5,209.43 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $833.51 / $833.51 / $833.51
| Facility | AS | $833.51 | $833.51 | $833.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.46 / $4,107.51 / $5,346.40
| Facility | | $3,183.46 | $4,107.51 | $5,346.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,780.00 / $13,193.00 / $26,782.00
| Facility | | $9,780.00 | $13,193.00 | $26,782.00 |