- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $616.60 / $14,454.40
| Facility | | $295.12 | $616.60 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $12,589.25 / $16,218.10
| Facility | | $6,456.54 | $12,589.25 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $912.01 / $1,445.44
| Facility | | $776.25 | $912.01 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $630.96 / $10,000.00
| Facility | | $309.03 | $630.96 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $691.83 / $14,125.38
| Facility | | $309.03 | $691.83 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $1,000.00
| Professional | | $446.68 | $691.83 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $5,011.87 / $5,011.87
| Facility | | $776.25 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $489.78 / $489.78 / $3,162.28
| Facility | 62 | $489.78 | $489.78 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.62 / $77.62 / $501.19
| Facility | AS | $77.62 | $77.62 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,489.63 / $17,378.01
| Facility | | $8,912.51 | $13,489.63 | $17,378.01 |