- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,126.30 / $9,721.74 / $16,058.34
| Facility | | $1,126.30 | $9,721.74 | $16,058.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $8,176.86
| Facility | | $606.10 | $606.10 | $8,176.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $809.42 / $1,057.06 / $1,483.68
| Facility | | $809.42 | $1,057.06 | $1,483.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.44 / $173.76 / $256.10
| Facility | AS | $138.44 | $173.76 | $256.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,126.60 / $26,542.00 / $27,023.05
| Facility | | $3,126.60 | $26,542.00 | $27,023.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.89 / $1,539.94 / $2,561.40
| Facility | AS | $190.89 | $1,539.94 | $2,561.40 |