- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,388.44 / $9,549.93
| Facility | | $645.65 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $208.93 / $323.59
| Facility | | $34.67 | $208.93 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | 62 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.89 / $20.89 / $20.89
| Facility | AS | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,630.27 / $6,456.54
| Facility | | $1,348.96 | $2,630.27 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,737.80 / $4,168.69
| Facility | | $331.13 | $1,737.80 | $4,168.69 |