- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.30 / $631.30 / $7,838.38
| Facility | | $631.30 | $631.30 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,349.67 / $14,108.40 / $22,319.96
| Facility | | $11,349.67 | $14,108.40 | $22,319.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.76 / $440.76 / $3,388.59
| Facility | | $440.76 | $440.76 | $3,388.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.36 / $43.36 / $43.36
| Facility | AS | $43.36 | $43.36 | $43.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.98 / $440.76 / $596.66
| Facility | | $367.98 | $440.76 | $596.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.36 / $43.36 / $43.36
| Facility | AS | $43.36 | $43.36 | $43.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,983.00 / $2,983.00 / $8,842.00
| Facility | | $2,983.00 | $2,983.00 | $8,842.00 |