- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.83 / $6,070.11 / $9,727.00
| Facility | | $1,029.83 | $6,070.11 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,212.44 / $5,192.92 / $10,638.59
| Facility | | $2,212.44 | $5,192.92 | $10,638.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.29 / $1,740.00 / $14,931.15
| Facility | | $1,013.29 | $1,740.00 | $14,931.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.85 / $100.85 / $100.85
| Facility | AS | $100.85 | $100.85 | $100.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.80 / $1,029.83 / $1,928.55
| Facility | | $896.80 | $1,029.83 | $1,928.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.88 / $128.88 / $238.00
| Facility | AS | $128.88 | $128.88 | $238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $17,186.00 / $24,161.00
| Facility | | $3,028.00 | $17,186.00 | $24,161.00 |