- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.68 / $5,846.47 / $9,710.65
| Facility | | $807.68 | $5,846.47 | $9,710.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,094.75 / $2,094.75 / $2,993.14
| Facility | | $2,094.75 | $2,094.75 | $2,993.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $7,651.78
| Facility | | $606.10 | $606.10 | $7,651.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.68 / $1,021.00 / $1,616.89
| Facility | | $807.68 | $1,021.00 | $1,616.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $136.37 / $142.94 / $255.55
| Facility | AS | $136.37 | $142.94 | $255.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $8,736.00 / $14,257.00
| Facility | | $2,629.00 | $8,736.00 | $14,257.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,845.75 / $25,287.75 / $26,542.00
| Facility | | $3,845.75 | $25,287.75 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $187.64 / $1,441.05 / $2,396.92
| Facility | AS | $187.64 | $1,441.05 | $2,396.92 |