- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.55 / $6,614.71 / $8,160.14
| Facility | | $514.55 | $6,614.71 | $8,160.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.05 / $566.50 / $617.21
| Facility | | $513.05 | $566.50 | $617.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.75 / $555.75 / $555.75
| Facility | | $555.75 | $555.75 | $555.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.33 / $55.33 / $55.33
| Facility | AS | $55.33 | $55.33 | $55.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,904.83 / $9,800.70 / $26,886.46
| Facility | | $3,904.83 | $9,800.70 | $26,886.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.00 / $2,450.00 / $2,450.00
| Facility | | $2,450.00 | $2,450.00 | $2,450.00 |