- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,786.30 / $8,317.64
| Facility | | $2,089.30 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,365.16 / $6,025.60
| Facility | | $1,230.27 | $4,365.16 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,548.82 / $10,232.93
| Facility | | $1,047.13 | $1,548.82 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $11,748.98
| Facility | 62 | $1,698.24 | $1,698.24 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.42 / $275.42 / $1,905.46
| Facility | AS | $275.42 | $275.42 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,128.31 / $11,220.18
| Facility | | $5,754.40 | $8,128.31 | $11,220.18 |