- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $436.52 / $14,454.40
| Facility | | $194.98 | $436.52 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $630.96 / $1,023.29
| Facility | | $549.54 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $436.52 / $10,471.29
| Facility | | $194.98 | $436.52 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $436.52 / $1,778.28
| Facility | | $208.93 | $436.52 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $478.63 / $707.95
| Professional | | $316.23 | $478.63 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $3,548.13
| Facility | | $549.54 | $549.54 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $338.84 / $338.84 / $2,238.72
| Facility | 62 | $338.84 | $338.84 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $54.95 / $54.95 / $354.81
| Facility | AS | $54.95 | $54.95 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $1,949.84
| Facility | | $1,023.29 | $1,584.89 | $1,949.84 |