- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.67 / $579.67 / $5,605.95
| Facility | | $579.67 | $579.67 | $5,605.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,498.60 / $3,936.29 / $7,756.98
| Facility | | $2,498.60 | $3,936.29 | $7,756.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.00 / $2,038.90 / $4,904.85
| Facility | | $1,437.00 | $2,038.90 | $4,904.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.33 / $67.33 / $67.33
| Facility | AS | $67.33 | $67.33 | $67.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,306.36 / $1,864.04 / $3,862.09
| Facility | | $1,306.36 | $1,864.04 | $3,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.90 / $1,029.09 / $4,708.43
| Facility | | $611.90 | $1,029.09 | $4,708.43 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $152.13 / $152.13 / $152.13
| Facility | AS | $152.13 | $152.13 | $152.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |