- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.65 / $1,173.65 / $6,781.00
| Facility | | $1,173.65 | $1,173.65 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,178.97 / $9,866.35
| Facility | | $2,088.76 | $5,178.97 | $9,866.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,848.75 / $4,041.97 / $9,723.50
| Facility | | $2,848.75 | $4,041.97 | $9,723.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.18 / $134.18 / $134.18
| Facility | AS | $134.18 | $134.18 | $134.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,589.78 / $3,695.33 / $7,656.30
| Facility | | $2,589.78 | $3,695.33 | $7,656.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.08 / $2,011.05 / $3,534.78
| Facility | | $1,215.08 | $2,011.05 | $3,534.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $303.14 / $303.14 / $303.14
| Facility | AS | $303.14 | $303.14 | $303.14 |
- 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 |