- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.49 / $1,557.49 / $4,828.00
| Facility | | $1,557.49 | $1,557.49 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $11,908.24
| Facility | | $2,088.76 | $5,302.71 | $11,908.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,770.56 / $5,349.87 / $12,869.85
| Facility | | $3,770.56 | $5,349.87 | $12,869.85 |
- 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
- $3,427.78 / $4,891.07 / $10,133.74
| Facility | | $3,427.78 | $4,891.07 | $10,133.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.11 / $2,668.36 / $4,388.49
| Facility | | $1,609.11 | $2,668.36 | $4,388.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $402.19 / $402.19 / $402.19
| Facility | AS | $402.19 | $402.19 | $402.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |