- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.53 / $730.86 / $4,716.00
| Facility | | $534.53 | $730.86 | $4,716.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,354.81 / $5,939.08 / $11,503.06
| Facility | | $2,354.81 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.88 / $2,560.87 / $6,160.52
| Facility | | $1,804.88 | $2,560.87 | $6,160.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $91.69 / $91.69 / $91.69
| Facility | AS | $91.69 | $91.69 | $91.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.80 / $2,341.25 / $4,850.80
| Facility | | $1,640.80 | $2,341.25 | $4,850.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.29 / $1,088.74 / $1,979.52
| Facility | | $657.29 | $1,088.74 | $1,979.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $247.81 / $247.81 / $247.81
| Facility | AS | $247.81 | $247.81 | $247.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |