- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,492.73 / $1,492.73 / $6,781.00
| Facility | | $1,492.73 | $1,492.73 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,107.24 / $12,197.67 / $25,424.06
| Facility | | $3,107.24 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,681.32 / $5,223.26 / $12,565.27
| Facility | | $3,681.32 | $5,223.26 | $12,565.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.10 / $184.10 / $184.10
| Facility | AS | $184.10 | $184.10 | $184.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,346.66 / $4,775.32 / $9,893.91
| Facility | | $3,346.66 | $4,775.32 | $9,893.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,632.08 / $2,646.86 / $5,913.00
| Facility | | $1,632.08 | $2,646.86 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $393.31 / $393.31 / $393.31
| Facility | AS | $393.31 | $393.31 | $393.31 |
- 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 |