- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,187.76 / $3,801.89
| Facility | | $851.14 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $16,218.10
| Facility | | $56.23 | $4,677.35 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | AS | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $1,230.27
| Facility | | $524.81 | $524.81 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $870.96 / $7,079.46
| Facility | | $380.19 | $870.96 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $14,791.08
| Facility | | $2,570.40 | $6,918.31 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $16,218.10
| Facility | | $56.23 | $4,677.35 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | AS | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $15,488.17
| Facility | | $2,570.40 | $7,244.36 | $15,488.17 |