- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.01 / $563.01 / $563.01
| Facility | | $563.01 | $563.01 | $563.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,757.16 / $5,939.08 / $11,966.76
| Facility | | $2,757.16 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.24 / $1,931.40 / $4,646.25
| Facility | | $1,361.24 | $1,931.40 | $4,646.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $65.95 / $65.95 / $65.95
| Facility | AS | $65.95 | $65.95 | $65.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,237.49 / $1,765.76 / $3,658.46
| Facility | | $1,237.49 | $1,765.76 | $3,658.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $618.84 / $967.66 / $1,682.27
| Facility | | $618.84 | $967.66 | $1,682.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $145.43 / $145.43 / $145.43
| Facility | AS | $145.43 | $145.43 | $145.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |