- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $9,332.54 / $16,595.87
| Facility | | $524.81 | $9,332.54 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $575.44 / $616.60
| Facility | | $34.67 | $575.44 | $616.60 |
- 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
- $537.03 / $537.03 / $630.96
| Professional | | $537.03 | $537.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $501.19 / $776.25
| Facility | | $346.74 | $501.19 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $16,595.87 / $25,703.96
| Facility | | $1,000.00 | $16,595.87 | $25,703.96 |