- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.39 / $7,838.38 / $7,838.38
| Facility | | $973.39 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.52 / $1,051.52 / $1,051.52
| Facility | | $1,051.52 | $1,051.52 | $1,051.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.94 / $102.94 / $102.94
| Facility | AS | $102.94 | $102.94 | $102.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.68 / $1,051.03 / $1,378.13
| Facility | | $777.68 | $1,051.03 | $1,378.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.94 / $102.94 / $102.94
| Facility | AS | $102.94 | $102.94 | $102.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.00 / $9,127.00 / $10,150.00
| Facility | | $1,230.00 | $9,127.00 | $10,150.00 |