- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,495.41 / $13,803.84
| Facility | | $1,659.59 | $5,495.41 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $9,332.54
| Facility | | $6,456.54 | $6,456.54 | $9,332.54 |
- 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
- $2,511.89 / $2,511.89 / $3,388.44
| Professional | | $2,511.89 | $2,511.89 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,949.84 / $3,090.30
| Facility | | $1,445.44 | $1,949.84 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $21,379.62 / $28,840.32
| Facility | | $9,332.54 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $18,197.01 / $18,197.01
| Facility | | $56.23 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $14,791.08
| Facility | 52 | $14,791.08 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | AS | $1,819.70 | $1,819.70 | $1,819.70 |