- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $6,760.83
| Facility | | $446.68 | $446.68 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,456.54 / $14,791.08
| Facility | | $2,691.53 | $6,456.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,659.59 / $3,981.07
| Facility | | $1,174.90 | $1,659.59 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Facility | AS | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,584.89 / $3,090.30
| Facility | | $1,288.25 | $1,584.89 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $891.25 / $6,918.31
| Facility | | $467.74 | $891.25 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,011.87 / $10,000.00
| Facility | | $2,818.38 | $5,011.87 | $10,000.00 |