- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.51 / $5,017.00 / $10,768.00
| Facility | | $1,004.51 | $5,017.00 | $10,768.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $6,025.59
| Facility | | $606.10 | $606.10 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.51 / $1,397.58 / $1,862.84
| Facility | | $1,004.51 | $1,397.58 | $1,862.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $191.40 / $195.66 / $331.89
| Facility | AS | $191.40 | $195.66 | $331.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $17,381.18 / $19,913.50
| Facility | | $1,400.00 | $17,381.18 | $19,913.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $230.35 / $1,134.79 / $1,887.52
| Facility | AS | $230.35 | $1,134.79 | $1,887.52 |