- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.27 / $1,463.27 / $7,859.00
| Facility | | $1,463.27 | $1,463.27 | $7,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,814.55 / $13,213.15 / $26,448.94
| Facility | | $6,814.55 | $13,213.15 | $26,448.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,553.36 / $5,041.71 / $12,128.52
| Facility | | $3,553.36 | $5,041.71 | $12,128.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.63 / $174.63 / $174.63
| Facility | AS | $174.63 | $174.63 | $174.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,230.33 / $4,609.33 / $9,550.01
| Facility | | $3,230.33 | $4,609.33 | $9,550.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.27 / $2,478.35 / $4,304.60
| Facility | | $1,463.27 | $2,478.35 | $4,304.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $378.42 / $378.42 / $378.42
| Facility | AS | $378.42 | $378.42 | $378.42 |
- 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 |