- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.24 / $1,037.24 / $6,781.00
| Facility | | $1,037.24 | $1,037.24 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,071.50 / $12,197.67 / $25,424.06
| Facility | | $2,071.50 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,557.48 / $3,628.69 / $8,729.31
| Facility | | $2,557.48 | $3,628.69 | $8,729.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.07 / $123.07 / $123.07
| Facility | AS | $123.07 | $123.07 | $123.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.98 / $3,317.50 / $6,873.48
| Facility | | $2,324.98 | $3,317.50 | $6,873.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.90 / $1,834.53 / $5,913.00
| Facility | | $1,095.90 | $1,834.53 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $272.62 / $272.62 / $272.62
| Facility | AS | $272.62 | $272.62 | $272.62 |
- 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 |