- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,348.96 / $7,585.78
| Facility | | $512.86 | $1,348.96 | $7,585.78 |
- 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
- $676.08 / $676.08 / $831.76
| Professional | | $676.08 | $676.08 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $467.74 / $741.31
| Facility | | $346.74 | $467.74 | $741.31 |
- 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 / $5,623.41 / $5,623.41
| Facility | | $56.23 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 62 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | AS | $562.34 | $562.34 | $562.34 |