- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,189.12 / $7,614.71 / $16,677.13
| Facility | | $3,189.12 | $7,614.71 | $16,677.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,313.90 / $6,765.20 / $11,599.21
| Facility | | $3,313.90 | $6,765.20 | $11,599.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $599.27 / $2,581.96
| Facility | | $580.00 | $599.27 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $59.43 / $59.43 / $59.43
| Facility | AS | $59.43 | $59.43 | $59.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.98 / $742.03 / $1,188.31
| Facility | | $579.98 | $742.03 | $1,188.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.84 / $104.44 / $168.84
| Facility | AS | $86.84 | $104.44 | $168.84 |
- 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 |