- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,611.22 / $1,611.22 / $6,781.00
| Facility | | $1,611.22 | $1,611.22 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $12,394.18
| Facility | | $2,088.76 | $5,302.71 | $12,394.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,906.09 / $5,542.18 / $13,332.46
| Facility | | $3,906.09 | $5,542.18 | $13,332.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.84 / $184.84 / $184.84
| Facility | AS | $184.84 | $184.84 | $184.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,550.99 / $5,066.88 / $10,498.00
| Facility | | $3,550.99 | $5,066.88 | $10,498.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,611.22 / $2,728.15 / $4,739.80
| Facility | | $1,611.22 | $2,728.15 | $4,739.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $416.83 / $416.83 / $416.83
| Facility | AS | $416.83 | $416.83 | $416.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.70 / $5,331.00 / $11,531.00
| Facility | | $1,172.70 | $5,331.00 | $11,531.00 |