- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,705.83 / $1,705.83 / $6,781.00
| Facility | | $1,705.83 | $1,705.83 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.96 / $830.40 / $13,456.54
| Facility | | $370.96 | $830.40 | $13,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,140.12 / $5,874.23 / $14,131.26
| Facility | | $4,140.12 | $5,874.23 | $14,131.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.26 / $202.26 / $202.26
| Facility | AS | $202.26 | $202.26 | $202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,763.75 / $5,370.46 / $11,126.98
| Facility | | $3,763.75 | $5,370.46 | $11,126.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,807.48 / $2,953.26 / $5,018.10
| Facility | | $1,807.48 | $2,953.26 | $5,018.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $441.09 / $441.09 / $441.09
| Facility | AS | $441.09 | $441.09 | $441.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |