- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,265.80 / $10,715.19
| Facility | | $1,819.70 | $4,265.80 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $17,378.01
| Facility | | $12,302.69 | $12,302.69 | $17,378.01 |
- 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
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,137.96 / $3,467.37
| Facility | | $1,819.70 | $2,137.96 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $25,703.96 / $43,651.58
| Facility | | $11,748.98 | $25,703.96 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $18,620.87 / $18,620.87
| Facility | | $56.23 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | 62 | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | AS | $1,862.09 | $1,862.09 | $1,862.09 |