- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.77 / $1,228.77 / $6,781.00
| Facility | | $1,228.77 | $1,228.77 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $10,438.48
| Facility | | $2,088.76 | $5,302.71 | $10,438.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,975.03 / $4,221.13 / $10,154.51
| Facility | | $2,975.03 | $4,221.13 | $10,154.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $140.69 / $140.69 / $140.69
| Facility | AS | $140.69 | $140.69 | $140.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,704.57 / $3,859.13 / $7,995.68
| Facility | | $2,704.57 | $3,859.13 | $7,995.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.08 / $2,103.10 / $5,577.00
| Facility | | $1,289.08 | $2,103.10 | $5,577.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $317.08 / $317.08 / $317.08
| Facility | AS | $317.08 | $317.08 | $317.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $13,109.00
| Facility | | $5,577.00 | $10,743.00 | $13,109.00 |