- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- 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
- $273.89 / $506.01 / $1,775.00
| Facility | | $273.89 | $506.01 | $1,775.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.37 / $146.69 / $146.69
| Facility | AS | $76.37 | $146.69 | $146.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.94 / $705.24 / $987.56
| Facility | | $362.94 | $705.24 | $987.56 |
- 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 |