- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.12 / $536.73 / $3,634.42
| Facility | | $357.12 | $536.73 | $3,634.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,954.49 / $6,889.31 / $13,089.90
| Facility | | $3,954.49 | $6,889.31 | $13,089.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.25 / $1,863.32 / $4,482.47
| Facility | | $1,313.25 | $1,863.32 | $4,482.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.88 / $60.88 / $60.88
| Facility | AS | $60.88 | $60.88 | $60.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,193.86 / $1,703.52 / $3,529.50
| Facility | | $1,193.86 | $1,703.52 | $3,529.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.23 / $736.07 / $1,518.45
| Facility | | $430.23 | $736.07 | $1,518.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.01 / $165.01 / $165.01
| Facility | AS | $165.01 | $165.01 | $165.01 |
- 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 |