- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.40 / $10,296.48 / $19,916.72
| Facility | | $7,828.40 | $10,296.48 | $19,916.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.54 / $504.20 / $1,775.00
| Facility | | $272.54 | $504.20 | $1,775.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $75.92 / $145.93 / $145.93
| Facility | AS | $75.92 | $145.93 | $145.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.20 / $701.60 / $986.54
| Facility | | $362.20 | $701.60 | $986.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |