- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.95 / $9,757.43 / $20,941.45
| Facility | | $658.95 | $9,757.43 | $20,941.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,792.12 / $10,337.65 / $18,018.52
| Facility | | $4,792.12 | $10,337.65 | $18,018.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $654.32 / $7,467.81
| Facility | | $580.00 | $654.32 | $7,467.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $65.13 / $65.13 / $65.13
| Facility | AS | $65.13 | $65.13 | $65.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.90 / $797.33 / $1,246.81
| Facility | | $624.90 | $797.33 | $1,246.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.03 / $112.00 / $167.57
| Facility | AS | $95.03 | $112.00 | $167.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |