- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.29 / $5,463.36 / $13,841.56
| Facility | | $2,166.29 | $5,463.36 | $13,841.56 |
- 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
- $231.29 / $404.76 / $1,775.00
| Facility | | $231.29 | $404.76 | $1,775.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.44 / $119.44 / $119.44
| Facility | AS | $119.44 | $119.44 | $119.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.66 / $576.20 / $821.77
| Facility | | $463.66 | $576.20 | $821.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |