- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,862.09 / $11,220.18
| Facility | | $478.63 | $1,862.09 | $11,220.18 |
- 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
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $575.44 / $933.25
| Facility | | $478.63 | $575.44 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $758.58 / $1,949.84
| Facility | | $173.78 | $758.58 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $7,585.78 / $7,585.78
| Facility | | $56.23 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | 62 | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | AS | $758.58 | $758.58 | $758.58 |