- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,818.38 / $8,709.64
| Facility | | $501.19 | $2,818.38 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $35,481.34
| Facility | | $489.78 | $575.44 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | 62 | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | AS | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Professional | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $707.95
| Facility | | $331.13 | $457.09 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,162.28 / $16,982.44
| Facility | | $645.65 | $3,162.28 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,137.96 / $2,137.96
| Facility | | $56.23 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 62 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | AS | $213.80 | $213.80 | $213.80 |