- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $5,623.41
| Facility | | $213.80 | $213.80 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $3,981.07 / $6,165.95
| Facility | | $158.49 | $3,981.07 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Facility | 50 | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,862.09
| Facility | | $549.54 | $776.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | AS | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $1,445.44
| Facility | | $602.56 | $741.31 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $380.19 / $1,737.80
| Facility | | $234.42 | $380.19 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,951.21 / $8,511.38
| Facility | | $602.56 | $2,951.21 | $8,511.38 |