- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $12,882.50
| Facility | | $794.33 | $794.33 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $14,125.38 / $32,359.37
| Facility | | $4,786.30 | $14,125.38 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,884.03 / $6,918.31
| Facility | | $2,041.74 | $2,884.03 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $5,495.41
| Facility | | $2,238.72 | $2,818.38 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,621.81 / $10,232.93
| Facility | | $831.76 | $1,621.81 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $5,754.40 / $12,589.25
| Facility | | $2,951.21 | $5,754.40 | $12,589.25 |