- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,168.70 / $1,168.70 / $6,781.00
| Facility | | $1,168.70 | $1,168.70 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,148.95 / $9,809.12
| Facility | | $2,088.76 | $5,148.95 | $9,809.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,837.81 / $4,026.44 / $9,686.15
| Facility | | $2,837.81 | $4,026.44 | $9,686.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $133.62 / $133.62 / $133.62
| Facility | AS | $133.62 | $133.62 | $133.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,579.83 / $3,681.13 / $7,626.89
| Facility | | $2,579.83 | $3,681.13 | $7,626.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,209.00 / $2,004.62 / $4,382.00
| Facility | | $1,209.00 | $2,004.62 | $4,382.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $302.12 / $302.12 / $302.12
| Facility | AS | $302.12 | $302.12 | $302.12 |
- 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 |