- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,133.64 / $2,133.64 / $2,133.64
| Facility | | $2,133.64 | $2,133.64 | $2,133.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,183.79 / $34,194.19 / $66,228.75
| Facility | | $10,183.79 | $34,194.19 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,268.17 / $7,474.77 / $17,981.58
| Facility | | $5,268.17 | $7,474.77 | $17,981.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $262.88 / $262.88 / $262.88
| Facility | AS | $262.88 | $262.88 | $262.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,789.25 / $6,833.74 / $14,158.73
| Facility | | $4,789.25 | $6,833.74 | $14,158.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,133.64 / $3,500.00 / $5,902.49
| Facility | | $2,133.64 | $3,500.00 | $5,902.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $562.04 / $562.04 / $562.04
| Facility | AS | $562.04 | $562.04 | $562.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.00 / $3,500.00 / $8,152.00
| Facility | | $1,720.00 | $3,500.00 | $8,152.00 |