- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.53 / $737.53 / $9,039.25
| Facility | | $737.53 | $737.53 | $9,039.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,168.23 / $5,677.11 / $11,146.35
| Facility | | $3,168.23 | $5,677.11 | $11,146.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,796.47 / $2,548.92 / $6,131.78
| Facility | | $1,796.47 | $2,548.92 | $6,131.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.26 / $85.26 / $85.26
| Facility | AS | $85.26 | $85.26 | $85.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,633.15 / $2,330.33 / $4,828.18
| Facility | | $1,633.15 | $2,330.33 | $4,828.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $765.68 / $1,445.88 / $4,974.00
| Facility | | $765.68 | $1,445.88 | $4,974.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $191.16 / $191.16 / $191.16
| Facility | AS | $191.16 | $191.16 | $191.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |