- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.13 / $713.85 / $11,194.11
| Facility | | $490.13 | $713.85 | $11,194.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,448.32 / $11,253.87 / $25,424.06
| Facility | | $2,448.32 | $11,253.87 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,721.54 / $2,442.62 / $5,876.05
| Facility | | $1,721.54 | $2,442.62 | $5,876.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.75 / $81.75 / $81.75
| Facility | AS | $81.75 | $81.75 | $81.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.04 / $2,233.14 / $4,626.81
| Facility | | $1,565.04 | $2,233.14 | $4,626.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.34 / $1,077.30 / $2,099.96
| Facility | | $595.34 | $1,077.30 | $2,099.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $219.66 / $219.66 / $219.66
| Facility | AS | $219.66 | $219.66 | $219.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |