- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.29 / $5,463.36 / $13,841.56
| Facility | | $2,166.29 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,744.80 / $41,753.08 / $80,763.95
| Facility | | $31,744.80 | $41,753.08 | $80,763.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.57 / $184.75 / $1,775.00
| Facility | | $105.57 | $184.75 | $1,775.00 |
- 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
- $211.25 / $262.52 / $376.46
| Facility | | $211.25 | $262.52 | $376.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |