- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.14 / $5,601.10 / $12,703.19
| Facility | | $1,006.14 | $5,601.10 | $12,703.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,239.85 / $11,253.87 / $25,424.06
| Facility | | $2,239.85 | $11,253.87 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,432.05 / $3,450.72 / $8,301.18
| Facility | | $2,432.05 | $3,450.72 | $8,301.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.08 / $114.08 / $114.08
| Facility | AS | $114.08 | $114.08 | $114.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,210.94 / $3,154.79 / $6,536.36
| Facility | | $2,210.94 | $3,154.79 | $6,536.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,038.00 / $2,031.58 / $9,642.76
| Facility | | $1,038.00 | $2,031.58 | $9,642.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $259.20 / $259.20 / $259.20
| Facility | AS | $259.20 | $259.20 | $259.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.00 / $5,457.00 / $12,722.00
| Facility | | $1,356.00 | $5,457.00 | $12,722.00 |