- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $2,089.30 / $3,715.35
| Facility | | $57.54 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $1,071.52 / $19,498.45
| Facility | | $107.15 | $1,071.52 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $27.54 / $27.54 / $27.54
| Facility | AS | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $114.82
| Facility | | $50.12 | $50.12 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $380.19 / $7,079.46
| Facility | | $51.29 | $380.19 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $1,071.52 / $19,498.45
| Facility | | $104.71 | $1,071.52 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $27.54 / $27.54 / $27.54
| Facility | AS | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |