- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.75 / $1,020.75 / $11,341.55
| Facility | | $1,020.75 | $1,020.75 | $11,341.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,745.03 / $13,126.55 / $25,424.06
| Facility | | $4,745.03 | $13,126.55 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.86 / $3,588.08 / $8,631.62
| Facility | | $2,528.86 | $3,588.08 | $8,631.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $122.70 / $122.70 / $122.70
| Facility | AS | $122.70 | $122.70 | $122.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,298.96 / $3,280.37 / $6,796.55
| Facility | | $2,298.96 | $3,280.37 | $6,796.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.26 / $1,765.85 / $2,943.09
| Facility | | $1,083.26 | $1,765.85 | $2,943.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.73 / $269.73 / $269.73
| Facility | AS | $269.73 | $269.73 | $269.73 |
- 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 |