- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.89 / $474.89 / $3,678.93
| Facility | | $474.89 | $474.89 | $3,678.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,215.17 / $11,716.49 / $25,424.06
| Facility | | $2,215.17 | $11,716.49 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.08 / $1,653.10 / $3,976.75
| Facility | | $1,165.08 | $1,653.10 | $3,976.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $53.50 / $53.50 / $53.50
| Facility | AS | $53.50 | $53.50 | $53.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.18 / $1,511.33 / $3,131.30
| Facility | | $1,059.18 | $1,511.33 | $3,131.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.07 / $850.00 / $2,735.00
| Facility | | $496.07 | $850.00 | $2,735.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.47 / $123.47 / $123.47
| Facility | AS | $123.47 | $123.47 | $123.47 |
- 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 |