- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $3,908.01 / $13,841.56
| Facility | | $1,506.15 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,971.48 / $16,841.75
| Facility | | $6,619.76 | $8,971.48 | $16,841.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.15 / $372.48 / $1,242.00
| Facility | | $222.15 | $372.48 | $1,242.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $105.52 / $105.52 / $105.52
| Facility | AS | $105.52 | $105.52 | $105.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.83 / $506.66 / $714.34
| Facility | | $393.83 | $506.66 | $714.34 |
- 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 |