- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,090.30 / $5,623.41
| Facility | | $1,479.11 | $3,090.30 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,089.30 / $13,803.84
| Facility | | $56.23 | $2,089.30 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | AS | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $741.31 / $1,380.38
| Facility | | $50.12 | $741.31 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,238.72 / $8,511.38
| Facility | | $302.00 | $2,238.72 | $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
- $56.23 / $2,089.30 / $13,803.84
| Facility | | $56.23 | $2,089.30 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | AS | $1,380.38 | $1,380.38 | $1,380.38 |
- 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 |