- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.44 / $6,953.60 / $13,730.65
| Facility | | $632.44 | $6,953.60 | $13,730.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.36 / $2,503.36 / $2,539.89
| Facility | | $2,503.36 | $2,503.36 | $2,539.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $7,790.59
| Facility | | $748.70 | $748.70 | $7,790.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.44 / $861.00 / $1,288.35
| Facility | | $632.44 | $861.00 | $1,288.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.13 / $120.54 / $200.10
| Facility | AS | $109.13 | $120.54 | $200.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,049.05 / $25,746.50 / $26,542.00
| Facility | | $3,049.05 | $25,746.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $148.41 / $1,467.19 / $2,440.41
| Facility | AS | $148.41 | $1,467.19 | $2,440.41 |