- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,511.38 / $14,454.40
| Facility | | $4,466.84 | $8,511.38 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $21,877.62 / $42,657.95
| Facility | | $16,595.87 | $21,877.62 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,801.89 / $13,803.84
| Facility | | $2,398.83 | $3,801.89 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | 62 | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | AS | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $7,585.78
| Professional | | $5,370.32 | $5,370.32 | $7,585.78 |
- 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 |