- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.80 / $1,243.80 / $6,781.00
| Facility | | $1,243.80 | $1,243.80 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $10,418.45
| Facility | | $2,088.76 | $5,302.71 | $10,418.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,016.28 / $4,279.66 / $10,295.29
| Facility | | $3,016.28 | $4,279.66 | $10,295.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $142.16 / $142.16 / $142.16
| Facility | AS | $142.16 | $142.16 | $142.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,742.07 / $3,912.64 / $8,106.54
| Facility | | $2,742.07 | $3,912.64 | $8,106.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.50 / $2,129.81 / $3,658.94
| Facility | | $1,288.50 | $2,129.81 | $3,658.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $320.97 / $320.97 / $320.97
| Facility | AS | $320.97 | $320.97 | $320.97 |
- 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 |