- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,538.21 / $1,538.21 / $6,781.00
| Facility | | $1,538.21 | $1,538.21 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.96 / $830.40 / $11,864.30
| Facility | | $370.96 | $830.40 | $11,864.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.88 / $5,302.10 / $12,754.91
| Facility | | $3,736.88 | $5,302.10 | $12,754.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $178.36 / $178.36 / $178.36
| Facility | AS | $178.36 | $178.36 | $178.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,397.17 / $4,847.39 / $10,043.24
| Facility | | $3,397.17 | $4,847.39 | $10,043.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,601.04 / $2,646.83 / $4,525.03
| Facility | | $1,601.04 | $2,646.83 | $4,525.03 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $397.14 / $397.14 / $397.14
| Facility | AS | $397.14 | $397.14 | $397.14 |
- 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 |