- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.77 / $621.02 / $2,625.87
| Facility | | $396.77 | $621.02 | $2,625.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.14 / $465.77 / $582.21
| Facility | | $388.14 | $465.77 | $582.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.46 / $444.46 / $444.46
| Facility | | $444.46 | $444.46 | $444.46 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $272.63 / $272.63 / $272.63
| Facility | 62 | $272.63 | $272.63 | $272.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.62 / $43.62 / $43.62
| Facility | AS | $43.62 | $43.62 | $43.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,046.82 / $5,046.82 / $5,046.82
| Facility | | $5,046.82 | $5,046.82 | $5,046.82 |