- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.48 / $1,319.48 / $6,575.00
| Facility | | $1,319.48 | $1,319.48 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,172.81 / $22,897.69 / $46,771.99
| Facility | | $6,172.81 | $22,897.69 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,196.43 / $4,535.27 / $10,910.20
| Facility | | $3,196.43 | $4,535.27 | $10,910.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $149.31 / $149.31 / $149.31
| Facility | AS | $149.31 | $149.31 | $149.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.84 / $4,146.32 / $8,590.70
| Facility | | $2,905.84 | $4,146.32 | $8,590.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.81 / $2,282.33 / $9,740.00
| Facility | | $1,343.81 | $2,282.33 | $9,740.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $337.62 / $337.62 / $337.62
| Facility | AS | $337.62 | $337.62 | $337.62 |
- 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 |