- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.47 / $8,960.00 / $14,301.82
| Facility | | $1,557.47 | $8,960.00 | $14,301.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,764.77 / $6,836.09 / $12,097.16
| Facility | | $2,764.77 | $6,836.09 | $12,097.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.04 / $815.00 / $2,581.96
| Facility | | $674.04 | $815.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.11 / $67.11 / $67.11
| Facility | AS | $67.11 | $67.11 | $67.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.02 / $781.50 / $1,281.13
| Facility | | $644.02 | $781.50 | $1,281.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.40 / $111.72 / $171.07
| Facility | AS | $92.40 | $111.72 | $171.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |