- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $15,848.93 / $15,848.93
| Facility | | $331.13 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $436.52
| Facility | | $346.74 | $346.74 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $549.54 / $549.54
| Facility | | $34.67 | $549.54 | $549.54 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |