- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $7,943.28 / $14,454.40
| Facility | | $2,089.30 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $41,686.94 / $81,283.05
| Facility | | $31,622.78 | $41,686.94 | $81,283.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,570.40 / $19,054.61
| Facility | | $1,698.24 | $2,570.40 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | 62 | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | AS | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,467.37 / $4,677.35
| Professional | | $3,235.94 | $3,467.37 | $4,677.35 |
- 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 |