- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,576.70 / $1,576.70 / $6,781.00
| Facility | | $1,576.70 | $1,576.70 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,329.37 / $14,268.42 / $26,806.48
| Facility | | $7,329.37 | $14,268.42 | $26,806.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,884.20 / $5,511.12 / $13,257.75
| Facility | | $3,884.20 | $5,511.12 | $13,257.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.61 / $194.61 / $194.61
| Facility | AS | $194.61 | $194.61 | $194.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,531.09 / $5,038.49 / $10,439.18
| Facility | | $3,531.09 | $5,038.49 | $10,439.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.92 / $2,782.29 / $5,913.00
| Facility | | $1,725.92 | $2,782.29 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $415.18 / $415.18 / $415.18
| Facility | AS | $415.18 | $415.18 | $415.18 |
- 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 |