- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.59 / $1,044.59 / $1,044.59
| Facility | | $1,044.59 | $1,044.59 | $1,044.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,812.60 / $13,126.55 / $25,424.06
| Facility | | $4,812.60 | $13,126.55 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,580.21 / $3,660.94 / $8,806.89
| Facility | | $2,580.21 | $3,660.94 | $8,806.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.39 / $126.39 / $126.39
| Facility | AS | $126.39 | $126.39 | $126.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,345.64 / $3,346.98 / $6,934.56
| Facility | | $2,345.64 | $3,346.98 | $6,934.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,119.60 / $1,800.56 / $3,053.00
| Facility | | $1,119.60 | $1,800.56 | $3,053.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.18 / $275.18 / $275.18
| Facility | AS | $275.18 | $275.18 | $275.18 |
- 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 |