- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $3,388.44 / $5,623.41
| Facility | | $338.84 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,137.96 / $7,585.78
| Facility | | $56.23 | $2,137.96 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 62 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | AS | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $1,380.38
| Facility | | $50.12 | $676.08 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $512.86 / $8,511.38
| Facility | | $302.00 | $512.86 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $5,011.87 / $13,182.57
| Facility | | $776.25 | $5,011.87 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,137.96 / $7,585.78
| Facility | | $56.23 | $2,137.96 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 62 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | AS | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,890.45 / $12,882.50
| Facility | | $794.33 | $3,890.45 | $12,882.50 |