- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.61 / $1,113.61 / $6,781.00
| Facility | | $1,113.61 | $1,113.61 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,014.18 / $9,539.56
| Facility | | $2,088.76 | $5,014.18 | $9,539.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.75 / $3,830.55 / $9,214.91
| Facility | | $2,699.75 | $3,830.55 | $9,214.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $127.13 / $127.13 / $127.13
| Facility | AS | $127.13 | $127.13 | $127.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.32 / $3,502.04 / $7,255.84
| Facility | | $2,454.32 | $3,502.04 | $7,255.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.10 / $1,906.65 / $3,351.58
| Facility | | $1,152.10 | $1,906.65 | $3,351.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $287.33 / $287.33 / $287.33
| Facility | AS | $287.33 | $287.33 | $287.33 |
- 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 |