- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $2,238.72
| Facility | | $338.84 | $338.84 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $870.96 / $1,348.96
| Facility | | $245.47 | $870.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,202.26 / $2,884.03
| Facility | | $851.14 | $1,202.26 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | 22 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | 62 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Facility | AS | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,174.90 / $2,290.87
| Facility | | $933.25 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $575.44 / $1,445.44
| Facility | | $346.74 | $575.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,862.09 / $3,467.37
| Facility | | $380.19 | $1,862.09 | $3,467.37 |