- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,105.24 / $8,477.27 / $21,899.37
| Facility | | $3,105.24 | $8,477.27 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.06 / $351.86 / $1,775.00
| Facility | | $201.06 | $351.86 | $1,775.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.77 / $105.67 / $105.67
| Facility | AS | $55.77 | $105.67 | $105.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.89 / $440.31 / $588.16
| Facility | | $217.89 | $440.31 | $588.16 |
- 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 |