- 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
- $286.38 / $501.17 / $4,317.00
| Facility | | $286.38 | $501.17 | $4,317.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $79.78 / $152.44 / $152.44
| Facility | AS | $79.78 | $152.44 | $152.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.83 / $654.65 / $1,024.04
| Facility | | $380.83 | $654.65 | $1,024.04 |
- 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 |