- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,150.82 / $17,369.43 / $43,511.16
| Facility | | $2,150.82 | $17,369.43 | $43,511.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,119.61 / $7,907.36 / $14,361.26
| Facility | | $2,119.61 | $7,907.36 | $14,361.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.78 / $5,637.55 / $7,244.35
| Facility | | $860.78 | $5,637.55 | $7,244.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.67 / $85.67 / $85.67
| Facility | AS | $85.67 | $85.67 | $85.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.51 / $985.26 / $1,745.52
| Facility | | $816.51 | $985.26 | $1,745.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $130.84 / $137.94 / $222.09
| Facility | AS | $130.84 | $137.94 | $222.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |