- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.44 / $6,660.85 / $14,184.80
| Facility | | $1,886.44 | $6,660.85 | $14,184.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,811.61 / $6,922.00 / $11,947.84
| Facility | | $2,811.61 | $6,922.00 | $11,947.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.34 / $890.00 / $2,581.96
| Facility | | $821.34 | $890.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.31 / $81.31 / $81.31
| Facility | AS | $81.31 | $81.31 | $81.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.33 / $943.91 / $1,556.42
| Facility | | $736.33 | $943.91 | $1,556.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.10 / $136.08 / $206.37
| Facility | AS | $114.10 | $136.08 | $206.37 |
- 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 |