- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.84 / $650.21 / $8,707.60
| Facility | | $65.84 | $650.21 | $8,707.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,051.36 / $12,197.67 / $25,424.06
| Facility | | $3,051.36 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.32 / $2,247.92 / $5,407.69
| Facility | | $1,584.32 | $2,247.92 | $5,407.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.45 / $73.45 / $73.45
| Facility | AS | $73.45 | $73.45 | $73.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.29 / $2,055.14 / $4,258.03
| Facility | | $1,440.29 | $2,055.14 | $4,258.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.87 / $1,137.14 / $5,913.00
| Facility | | $706.87 | $1,137.14 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $168.45 / $168.45 / $168.45
| Facility | AS | $168.45 | $168.45 | $168.45 |
- 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 |