- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,059.38 / $9,047.15 / $13,949.71
| Facility | | $4,059.38 | $9,047.15 | $13,949.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,307.10 / $11,258.34 / $19,407.11
| Facility | | $4,307.10 | $11,258.34 | $19,407.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.44 / $2,345.00 / $5,740.31
| Facility | | $1,154.44 | $2,345.00 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.57 / $114.57 / $114.57
| Facility | AS | $114.57 | $114.57 | $114.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.44 / $1,367.11 / $2,225.94
| Facility | | $1,128.44 | $1,367.11 | $2,225.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $187.20 / $191.40 / $303.67
| Facility | AS | $187.20 | $191.40 | $303.67 |
- 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 |