- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.46 / $1,181.46 / $6,781.00
| Facility | | $1,181.46 | $1,181.46 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $7,219.20 / $13,089.90
| Facility | | $4,206.67 | $7,219.20 | $13,089.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,867.27 / $4,068.25 / $9,786.71
| Facility | | $2,867.27 | $4,068.25 | $9,786.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $135.00 / $135.00 / $135.00
| Facility | AS | $135.00 | $135.00 | $135.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,606.61 / $3,719.35 / $7,706.08
| Facility | | $2,606.61 | $3,719.35 | $7,706.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.43 / $2,024.77 / $3,475.56
| Facility | | $1,223.43 | $2,024.77 | $3,475.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $305.14 / $305.14 / $305.14
| Facility | AS | $305.14 | $305.14 | $305.14 |
- 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 |