- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,859.66 / $2,445.96 / $4,731.27
| Facility | | $1,859.66 | $2,445.96 | $4,731.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.56 / $1,407.58 / $4,406.00
| Facility | | $944.56 | $1,407.58 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $381.48 / $381.48 / $381.48
| Facility | AS | $381.48 | $381.48 | $381.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.31 / $1,834.04 / $2,473.73
| Facility | | $1,490.31 | $1,834.04 | $2,473.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |