- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,646.26 / $7,660.10 / $16,677.13
| Facility | | $1,646.26 | $7,660.10 | $16,677.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,194.19 / $6,740.14 / $11,552.91
| Facility | | $3,194.19 | $6,740.14 | $11,552.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $707.51 / $2,581.96
| Facility | | $580.00 | $707.51 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.31 / $70.31 / $70.31
| Facility | AS | $70.31 | $70.31 | $70.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.63 / $816.00 / $1,348.51
| Facility | | $682.63 | $816.00 | $1,348.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.14 / $117.72 / $215.43
| Facility | AS | $103.14 | $117.72 | $215.43 |
- 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 |