- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $7,943.28 / $14,125.38
| Facility | | $3,019.95 | $7,943.28 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $18,620.87 / $38,018.94
| Facility | | $14,791.08 | $18,620.87 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,344.23 / $9,772.37
| Facility | | $1,348.96 | $2,344.23 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | 62 | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | AS | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,467.37 / $4,786.30
| Professional | | $2,818.38 | $3,467.37 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,511.38 / $14,125.38
| Facility | | $7,079.46 | $8,511.38 | $14,125.38 |