- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,186.53 / $3,576.15 / $7,394.24
| Facility | | $2,186.53 | $3,576.15 | $7,394.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.80 / $1,144.04 / $2,251.11
| Professional | | $704.80 | $1,144.04 | $2,251.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.81 / $1,683.26 / $2,171.46
| Facility | | $1,150.81 | $1,683.26 | $2,171.46 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,168.54 / $2,168.54 / $2,168.54
| Facility | 62 | $2,168.54 | $2,168.54 | $2,168.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $346.97 / $346.97 / $346.97
| Facility | AS | $346.97 | $346.97 | $346.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.41 / $1,683.26 / $2,181.79
| Facility | | $1,315.41 | $1,683.26 | $2,181.79 |
- 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 |