- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.75 / $7,655.45 / $25,492.35
| Facility | | $2,232.75 | $7,655.45 | $25,492.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,049.08 / $15,050.77 / $25,563.66
| Facility | | $7,049.08 | $15,050.77 | $25,563.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $13,875.49
| Facility | | $580.00 | $890.00 | $13,875.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.58 / $94.58 / $94.58
| Facility | AS | $94.58 | $94.58 | $94.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.09 / $1,135.10 / $1,834.75
| Facility | | $859.09 | $1,135.10 | $1,834.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.01 / $169.12 / $244.86
| Facility | AS | $134.01 | $169.12 | $244.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,766.00 / $17,186.00 / $25,620.00
| Facility | | $8,766.00 | $17,186.00 | $25,620.00 |