- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,115.73 / $2,115.73 / $2,115.73
| Facility | | $2,115.73 | $2,115.73 | $2,115.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,921.01 / $34,194.19 / $66,228.75
| Facility | | $9,921.01 | $34,194.19 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,214.30 / $7,398.33 / $17,797.68
| Facility | | $5,214.30 | $7,398.33 | $17,797.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.88 / $257.88 / $257.88
| Facility | AS | $257.88 | $257.88 | $257.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,740.27 / $6,763.85 / $14,013.93
| Facility | | $4,740.27 | $6,763.85 | $14,013.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,115.73 / $3,500.00 / $5,876.62
| Facility | | $2,115.73 | $3,500.00 | $5,876.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $559.38 / $559.38 / $559.38
| Facility | AS | $559.38 | $559.38 | $559.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.00 / $2,260.00 / $5,530.00
| Facility | | $1,356.00 | $2,260.00 | $5,530.00 |