- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.11 / $183.63 / $371.20
| Professional | | $127.11 | $183.63 | $371.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.44 / $290.61 / $1,914.00
| Facility | | $154.44 | $290.61 | $1,914.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $340.62 / $340.62 / $340.62
| Facility | 62 | $340.62 | $340.62 | $340.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $54.50 / $54.50 / $54.50
| Facility | AS | $54.50 | $54.50 | $54.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.13 / $290.61 / $376.46
| Facility | | $231.13 | $290.61 | $376.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |