- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,454.74 / $10,032.00 / $27,827.10
| Facility | | $5,454.74 | $10,032.00 | $27,827.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,749.41 / $9,096.90 / $23,922.76
| Facility | | $2,749.41 | $9,096.90 | $23,922.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,104.88 / $7,567.35
| Facility | | $580.00 | $1,104.88 | $7,567.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.68 / $109.68 / $109.68
| Facility | AS | $109.68 | $109.68 | $109.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.16 / $1,395.50 / $2,498.40
| Facility | | $1,096.16 | $1,395.50 | $2,498.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $167.04 / $199.08 / $388.25
| Facility | AS | $167.04 | $199.08 | $388.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,465.00 / $16,109.00 / $24,729.00
| Facility | | $7,465.00 | $16,109.00 | $24,729.00 |