- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,311.31 / $5,128.61
| Facility | | $1,778.28 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,818.38 / $14,791.08
| Facility | | $812.83 | $2,818.38 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | AS | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $741.31
| Facility | | $50.12 | $676.08 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,398.83 / $8,511.38
| Facility | | $302.00 | $2,398.83 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,454.71 / $4,677.35
| Facility | | $295.12 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,818.38 / $14,791.08
| Facility | | $812.83 | $2,818.38 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | AS | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,754.23 / $4,677.35
| Facility | | $794.33 | $2,754.23 | $4,677.35 |