- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,325.90 / $6,050.00 / $11,309.07
| Facility | | $1,325.90 | $6,050.00 | $11,309.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,902.11 / $2,902.11 / $2,902.11
| Facility | AS | $2,902.11 | $2,902.11 | $2,902.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.00 / $7,363.00 / $15,579.70
| Facility | | $4,100.00 | $7,363.00 | $15,579.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,360.21 / $2,792.50 / $3,376.72
| Facility | | $2,360.21 | $2,792.50 | $3,376.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.24 / $104.24 / $104.24
| Facility | AS | $104.24 | $104.24 | $104.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,622.00
| Facility | | $2,637.00 | $5,735.00 | $9,622.00 |