- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,184.08 / $6,163.62 / $16,862.91
| Facility | | $2,184.08 | $6,163.62 | $16,862.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $629.00 / $8,742.00
| Facility | | $582.00 | $629.00 | $8,742.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,070.46 / $1,070.46 / $1,070.46
| Facility | 62 | $1,070.46 | $1,070.46 | $1,070.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.27 / $171.27 / $171.27
| Facility | AS | $171.27 | $171.27 | $171.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,490.55 / $1,848.28 / $2,644.96
| Professional | | $1,490.55 | $1,848.28 | $2,644.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,541.00 / $2,139.00 / $6,125.00
| Facility | | $1,541.00 | $2,139.00 | $6,125.00 |