- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,691.53 / $7,585.78
| Facility | | $1,258.93 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,760.83 / $9,772.37
| Facility | | $3,467.37 | $6,760.83 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $9,772.37 / $9,772.37
| Facility | | $54.95 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | 54 | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | AS | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,754.40 / $10,232.93
| Facility | | $3,235.94 | $5,754.40 | $10,232.93 |