- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.21 / $6,953.60 / $14,820.44
| Facility | | $1,063.21 | $6,953.60 | $14,820.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,397.92 / $4,397.92 / $6,284.08
| Facility | | $4,397.92 | $4,397.92 | $6,284.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $15,414.70
| Facility | | $748.70 | $748.70 | $15,414.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.21 / $1,339.06 / $2,216.17
| Facility | | $1,063.21 | $1,339.06 | $2,216.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.98 / $187.47 / $336.40
| Facility | AS | $182.98 | $187.47 | $336.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,068.89 / $44,464.66 / $50,942.85
| Facility | | $5,068.89 | $44,464.66 | $50,942.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $246.18 / $2,903.03 / $4,828.66
| Facility | AS | $246.18 | $2,903.03 | $4,828.66 |