- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.07 / $5,545.58 / $14,468.92
| Facility | | $1,005.07 | $5,545.58 | $14,468.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,246.78 / $11,253.87 / $25,424.06
| Facility | | $2,246.78 | $11,253.87 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,441.31 / $3,463.86 / $8,332.79
| Facility | | $2,441.31 | $3,463.86 | $8,332.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.57 / $114.57 / $114.57
| Facility | AS | $114.57 | $114.57 | $114.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,219.37 / $3,166.80 / $6,561.25
| Facility | | $2,219.37 | $3,166.80 | $6,561.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.56 / $1,951.60 / $9,370.00
| Facility | | $1,036.56 | $1,951.60 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.80 / $258.80 / $258.80
| Facility | AS | $258.80 | $258.80 | $258.80 |
- 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 |