- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.29 / $5,463.36 / $13,841.56
| Facility | | $2,166.29 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,324.16 / $9,926.11 / $18,633.84
| Facility | | $7,324.16 | $9,926.11 | $18,633.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.53 / $373.41 / $1,242.00
| Facility | | $225.53 | $373.41 | $1,242.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.63 / $107.63 / $107.63
| Facility | AS | $107.63 | $107.63 | $107.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.25 / $508.49 / $723.74
| Facility | | $395.25 | $508.49 | $723.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |