- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,165.95 / $10,964.78
| Facility | | $2,344.23 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,248.07 / $8,128.31
| Facility | | $1,659.59 | $5,248.07 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,995.26 / $8,511.38
| Facility | | $1,412.54 | $1,995.26 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $13,182.57
| Facility | 62 | $2,344.23 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $371.54 / $2,089.30 / $2,089.30
| Facility | AS | $371.54 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $10,715.19
| Facility | | $2,818.38 | $7,079.46 | $10,715.19 |