- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.66 / $5,107.20 / $11,545.94
| Facility | | $1,763.66 | $5,107.20 | $11,545.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,764.77 / $6,463.49 / $11,947.84
| Facility | | $2,764.77 | $6,463.49 | $11,947.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.22 / $2,345.00 / $2,581.96
| Facility | | $759.22 | $2,345.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $75.45 / $75.45 / $75.45
| Facility | AS | $75.45 | $75.45 | $75.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.18 / $850.82 / $1,449.64
| Facility | | $687.18 | $850.82 | $1,449.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.03 / $119.11 / $193.30
| Facility | AS | $109.03 | $119.11 | $193.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,327.00 / $13,190.00 / $19,665.00
| Facility | | $2,327.00 | $13,190.00 | $19,665.00 |