- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,073.80 / $12,589.25
| Facility | | $2,041.74 | $4,073.80 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $41,686.94 / $81,283.05
| Facility | | $31,622.78 | $41,686.94 | $81,283.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $199.53 / $4,365.16
| Facility | | $134.90 | $199.53 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Facility | 62 | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $54.95 / $54.95 / $54.95
| Facility | AS | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $288.40 / $380.19
| Professional | | $263.03 | $288.40 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $4,570.88
| Facility | | $1,096.48 | $1,548.82 | $4,570.88 |