- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.09 / $4,738.00 / $10,510.25
| Facility | | $1,118.09 | $4,738.00 | $10,510.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $16,269.62 / $16,269.62 / $16,269.62
| Facility | AS | $16,269.62 | $16,269.62 | $16,269.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $6,474.00 / $12,444.00
| Facility | | $3,248.00 | $6,474.00 | $12,444.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $2,018.66 / $4,226.60
| Facility | | $842.00 | $2,018.66 | $4,226.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $74.34 / $74.34 / $74.34
| Facility | AS | $74.34 | $74.34 | $74.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |