- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,143.43 / $6,431.17 / $9,640.40
| Facility | | $1,143.43 | $6,431.17 | $9,640.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,736.14 / $5,736.14 / $8,196.23
| Facility | | $5,736.14 | $5,736.14 | $8,196.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $8,198.17
| Facility | | $606.10 | $606.10 | $8,198.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.94 / $935.00 / $1,493.56
| Facility | | $696.94 | $935.00 | $1,493.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $122.51 / $130.90 / $220.51
| Facility | AS | $122.51 | $130.90 | $220.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,332.55 / $26,542.00 / $27,093.50
| Facility | | $3,332.55 | $26,542.00 | $27,093.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.55 / $1,543.95 / $2,568.08
| Facility | AS | $162.55 | $1,543.95 | $2,568.08 |