- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,829.46 / $1,829.46 / $6,781.00
| Facility | | $1,829.46 | $1,829.46 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $14,051.05
| Facility | | $2,088.76 | $5,302.71 | $14,051.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,427.18 / $6,281.53 / $15,111.08
| Facility | | $4,427.18 | $6,281.53 | $15,111.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $209.94 / $209.94 / $209.94
| Facility | AS | $209.94 | $209.94 | $209.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,024.71 / $5,742.83 / $11,898.49
| Facility | | $4,024.71 | $5,742.83 | $11,898.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,888.37 / $3,091.79 / $5,331.00
| Facility | | $1,888.37 | $3,091.79 | $5,331.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $472.53 / $472.53 / $472.53
| Facility | AS | $472.53 | $472.53 | $472.53 |
- 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 |