- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,786.30 / $8,317.64
| Facility | | $1,047.13 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $21,379.62 / $57,543.99
| Facility | | $20,417.38 | $21,379.62 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $117.49 / $117.49 / $117.49
| Facility | AS | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,801.89 / $8,317.64
| Facility | | $954.99 | $3,801.89 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $1,412.54
| Facility | | $954.99 | $954.99 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $891.25
| Facility | | $676.08 | $831.76 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,981.07 / $10,000.00
| Facility | | $2,137.96 | $3,981.07 | $10,000.00 |