- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $154.88 / $2,238.72
| Facility | | $154.88 | $154.88 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $398.11 / $630.96
| Facility | | $1.00 | $398.11 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $1,348.96
| Facility | | $398.11 | $562.34 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $28.18 / $28.18 / $28.18
| Facility | AS | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $1,047.13
| Facility | | $436.52 | $537.03 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $309.03 / $3,981.07
| Facility | | $169.82 | $309.03 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,265.80 / $10,000.00
| Facility | | $1,445.44 | $4,265.80 | $10,000.00 |