- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.33 / $3,921.30 / $16,201.39
| Facility | | $1,120.33 | $3,921.30 | $16,201.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,173.62 / $22,897.69 / $46,771.99
| Facility | | $5,173.62 | $22,897.69 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,716.59 / $3,854.44 / $9,272.37
| Facility | | $2,716.59 | $3,854.44 | $9,272.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.35 / $126.35 / $126.35
| Facility | AS | $126.35 | $126.35 | $126.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,469.62 / $3,523.88 / $7,301.09
| Facility | | $2,469.62 | $3,523.88 | $7,301.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,135.26 / $1,941.82 / $9,370.00
| Facility | | $1,135.26 | $1,941.82 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $286.66 / $286.66 / $286.66
| Facility | AS | $286.66 | $286.66 | $286.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |