- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $6,025.60 / $9,549.93
| Facility | | $1,412.54 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,585.78 / $57,543.99
| Facility | | $6,456.54 | $7,585.78 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,513.56
| Facility | | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | AS | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,128.61 / $9,549.93
| Facility | | $1,122.02 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,862.09
| Facility | | $1,202.26 | $1,202.26 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $1,071.52
| Facility | | $691.83 | $691.83 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,981.07 / $10,000.00
| Facility | | $2,089.30 | $3,981.07 | $10,000.00 |