- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.39 / $1,020.00 / $8,413.00
| Facility | | $581.39 | $1,020.00 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.39 / $833.11 / $1,100.90
| Facility | | $581.39 | $833.11 | $1,100.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $115.22 / $116.64 / $192.09
| Facility | AS | $115.22 | $116.64 | $192.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,574.72 / $10,574.72
| Facility | | $55.00 | $10,574.72 | $10,574.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.48 / $144.18 / $279.77
| Facility | AS | $81.48 | $144.18 | $279.77 |