- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $5,011.87
| Facility | | $724.44 | $724.44 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $12,882.50 / $38,904.51
| Facility | | $7,244.36 | $12,882.50 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,398.83 / $5,754.40
| Facility | | $1,698.24 | $2,398.83 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,344.23 / $4,570.88
| Facility | | $1,862.09 | $2,344.23 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,819.70 / $12,302.69
| Facility | | $1,122.02 | $1,819.70 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,000.00 / $14,125.38
| Facility | | $4,897.79 | $10,000.00 | $14,125.38 |