- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.27 / $1,670.73 / $8,413.00
| Facility | | $406.27 | $1,670.73 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $1,215.60
| Facility | | $606.10 | $606.10 | $1,215.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.27 / $522.35 / $765.93
| Facility | | $406.27 | $522.35 | $765.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.13 / $73.13 / $134.22
| Facility | AS | $73.13 | $73.13 | $134.22 |
- 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 / $3,506.49 / $4,017.35
| Facility | | $55.00 | $3,506.49 | $4,017.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $96.50 / $228.94 / $380.79
| Facility | AS | $96.50 | $228.94 | $380.79 |