- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,675.36 / $8,042.03 / $19,276.96
| Facility | | $3,675.36 | $8,042.03 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,949.61 / $3,879.54 / $7,504.28
| Facility | | $2,949.61 | $3,879.54 | $7,504.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.42 / $1,062.42 / $1,062.42
| Facility | | $1,062.42 | $1,062.42 | $1,062.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.31 / $706.62 / $4,192.00
| Facility | | $382.31 | $706.62 | $4,192.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.42 / $380.79 / $380.79
| Facility | AS | $108.42 | $380.79 | $380.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.72 / $1,031.44 / $1,331.66
| Facility | | $628.72 | $1,031.44 | $1,331.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.91 / $2,753.18 / $7,772.00
| Facility | | $2,016.91 | $2,753.18 | $7,772.00 |