- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $7,943.28 / $14,454.40
| Facility | | $380.19 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,398.83 / $4,677.35
| Facility | | $1,862.09 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $354.81 / $4,365.16
| Facility | | $199.53 | $354.81 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | 52 | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | 62 | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Facility | AS | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $478.63 / $660.69
| Professional | | $457.09 | $478.63 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |