- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.08 / $596.08 / $9,629.68
| Facility | | $596.08 | $596.08 | $9,629.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,722.50 / $5,396.85 / $11,503.06
| Facility | | $2,722.50 | $5,396.85 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,453.84 / $2,062.79 / $4,962.32
| Facility | | $1,453.84 | $2,062.79 | $4,962.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.59 / $67.59 / $67.59
| Facility | AS | $67.59 | $67.59 | $67.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.67 / $1,885.88 / $3,907.34
| Facility | | $1,321.67 | $1,885.88 | $3,907.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.51 / $1,043.07 / $5,499.00
| Facility | | $609.51 | $1,043.07 | $5,499.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $153.93 / $153.93 / $153.93
| Facility | AS | $153.93 | $153.93 | $153.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |