- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.48 / $1,532.48 / $6,781.00
| Facility | | $1,532.48 | $1,532.48 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,093.17 / $13,917.02 / $26,448.94
| Facility | | $7,093.17 | $13,917.02 | $26,448.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,780.66 / $5,364.21 / $12,904.33
| Facility | | $3,780.66 | $5,364.21 | $12,904.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $189.62 / $189.62 / $189.62
| Facility | AS | $189.62 | $189.62 | $189.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,436.96 / $4,904.17 / $10,160.89
| Facility | | $3,436.96 | $4,904.17 | $10,160.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,678.32 / $2,701.17 / $5,913.00
| Facility | | $1,678.32 | $2,701.17 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $402.97 / $402.97 / $402.97
| Facility | AS | $402.97 | $402.97 | $402.97 |
- 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 |