- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.74 / $1,112.74 / $6,781.00
| Facility | | $1,112.74 | $1,112.74 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,223.39 / $12,197.67 / $25,424.06
| Facility | | $4,223.39 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,845.23 / $3,939.77 / $9,401.68
| Facility | | $2,845.23 | $3,939.77 | $9,401.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $136.44 / $136.44 / $136.44
| Facility | AS | $136.44 | $136.44 | $136.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,047.54 / $3,730.08 / $7,402.90
| Facility | | $3,047.54 | $3,730.08 | $7,402.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.98 / $1,981.82 / $9,370.00
| Facility | | $1,203.98 | $1,981.82 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $294.54 / $294.54 / $294.54
| Facility | AS | $294.54 | $294.54 | $294.54 |
- 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 |