- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.21 / $4,557.00 / $8,661.66
| Facility | | $882.21 | $4,557.00 | $8,661.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,433.97 / $7,628.77
| Facility | | $2,088.76 | $4,433.97 | $7,628.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.41 / $3,032.67 / $7,295.50
| Facility | | $2,137.41 | $3,032.67 | $7,295.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.81 / $100.81 / $100.81
| Facility | AS | $100.81 | $100.81 | $100.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.10 / $2,772.59 / $5,744.49
| Facility | | $1,943.10 | $2,772.59 | $5,744.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.11 / $1,490.93 / $3,940.00
| Facility | | $911.11 | $1,490.93 | $3,940.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.46 / $227.46 / $227.46
| Facility | AS | $227.46 | $227.46 | $227.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |