- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $2,691.53 / $9,549.93
| Facility | | $354.81 | $2,691.53 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,548.13 / $3,715.35 / $3,715.35
| Facility | 22 | $3,548.13 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Facility | 62 | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | 80 | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $0.40 / $0.40 / $0.40
| Facility | AS | $0.40 | $0.40 | $0.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $537.03 / $1,995.26
| Professional | | $239.88 | $537.03 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $27.54 / $70.79 / $213.80
| Professional | AS | $27.54 | $70.79 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,511.38 / $16,982.44
| Facility | | $4,570.88 | $8,511.38 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $691.83
| Professional | | $245.47 | $346.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $33.88 / $44.67 / $91.20
| Professional | AS | $33.88 | $44.67 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $741.31 / $46,773.51
| Facility | | $436.52 | $741.31 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | 22 | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | 62 | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Facility | AS | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $389.05 / $794.33
| Professional | | $257.04 | $389.05 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,202.26 / $3,801.89
| Facility | | $269.15 | $1,202.26 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $323.59 / $575.44
| Professional | | $218.78 | $323.59 | $575.44 |