- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,786.30 / $20,417.38
| Facility | | $1,778.28 | $4,786.30 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $11,481.54
| Facility | | $2,238.72 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $11,481.54 / $14,791.08
| Facility | | $5,754.40 | $11,481.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,445.44 / $7,244.36
| Facility | | $724.44 | $1,445.44 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $245.47 / $7,943.28 / $7,943.28
| Facility | AS | $245.47 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,265.80 / $15,848.93
| Facility | | $2,884.03 | $4,265.80 | $15,848.93 |