- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $6,760.83
| Facility | | $707.95 | $707.95 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,585.78 / $15,848.93
| Facility | | $4,265.80 | $7,585.78 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,630.27 / $6,309.57
| Facility | | $1,862.09 | $2,630.27 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,511.89 / $4,897.79
| Facility | | $2,041.74 | $2,511.89 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,348.96 / $6,918.31
| Facility | | $724.44 | $1,348.96 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,495.41 / $10,000.00
| Facility | | $1,584.89 | $5,495.41 | $10,000.00 |