- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $5,623.41
| Facility | | $478.63 | $478.63 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,760.83 / $14,791.08
| Facility | | $2,818.38 | $6,760.83 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $4,168.69
| Facility | | $1,230.27 | $1,737.80 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Facility | AS | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,698.24 / $3,311.31
| Facility | | $1,348.96 | $1,698.24 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $954.99 / $7,079.46
| Facility | | $489.78 | $954.99 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,011.87 / $10,000.00
| Facility | | $2,818.38 | $5,011.87 | $10,000.00 |