- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.08 / $240.08 / $240.08
| Facility | | $240.08 | $240.08 | $240.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.92 / $32,422.94 / $66,228.75
| Facility | | $2,269.92 | $32,422.94 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.28 / $836.10 / $2,011.36
| Facility | | $589.28 | $836.10 | $2,011.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $29.68 / $29.68 / $29.68
| Facility | AS | $29.68 | $29.68 | $29.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.71 / $764.40 / $1,583.75
| Facility | | $535.71 | $764.40 | $1,583.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.33 / $421.52 / $1,260.00
| Facility | | $269.33 | $421.52 | $1,260.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $63.29 / $63.29 / $63.29
| Facility | AS | $63.29 | $63.29 | $63.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.00 / $3,500.00 / $8,152.00
| Facility | | $1,720.00 | $3,500.00 | $8,152.00 |