- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,230.27 / $8,128.31
| Facility | | $478.63 | $1,230.27 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $8,128.31
| Facility | | $5,754.40 | $5,754.40 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $758.58
| Professional | | $645.65 | $645.65 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $436.52 / $707.95
| Facility | | $316.23 | $436.52 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $15,135.61 / $22,908.68
| Facility | | $5,370.32 | $15,135.61 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | 62 | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | AS | $501.19 | $501.19 | $501.19 |