- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $6,456.54 / $20,892.96
| Facility | | $467.74 | $6,456.54 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,041.74 / $2,951.21
| Facility | | $776.25 | $2,041.74 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $891.25
| Facility | | $549.54 | $549.54 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Facility | 22 | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | 62 | $346.74 | $346.74 | $346.74 |
- 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
- $645.65 / $645.65 / $758.58
| Professional | | $645.65 | $645.65 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $812.83
| Facility | | $316.23 | $467.74 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $19,952.62 / $25,703.96
| Facility | | $4,677.35 | $19,952.62 | $25,703.96 |