- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,026.83 / $9,047.14 / $19,020.05
| Facility | | $3,026.83 | $9,047.14 | $19,020.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,307.10 / $11,086.48 / $19,346.00
| Facility | | $4,307.10 | $11,086.48 | $19,346.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,126.75 / $2,345.00 / $5,740.31
| Facility | | $1,126.75 | $2,345.00 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.77 / $111.77 / $111.77
| Facility | AS | $111.77 | $111.77 | $111.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,101.20 / $1,341.44 / $2,158.85
| Facility | | $1,101.20 | $1,341.44 | $2,158.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $183.71 / $187.80 / $297.54
| Facility | AS | $183.71 | $187.80 | $297.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |