- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.04 / $546.04 / $5,957.76
| Facility | | $546.04 | $546.04 | $5,957.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,440.09 / $3,936.29 / $7,573.89
| Facility | | $2,440.09 | $3,936.29 | $7,573.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.98 / $1,918.26 / $4,614.64
| Facility | | $1,351.98 | $1,918.26 | $4,614.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $63.12 / $63.12 / $63.12
| Facility | AS | $63.12 | $63.12 | $63.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.07 / $1,753.75 / $3,633.58
| Facility | | $1,229.07 | $1,753.75 | $3,633.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.04 / $949.32 / $3,632.99
| Facility | | $546.04 | $949.32 | $3,632.99 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $143.22 / $143.22 / $143.22
| Facility | AS | $143.22 | $143.22 | $143.22 |
- 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 |