- 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
- $320.44 / $560.77 / $1,775.00
| Facility | | $320.44 | $560.77 | $1,775.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.31 / $165.31 / $165.31
| Facility | AS | $165.31 | $165.31 | $165.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.48 / $797.18 / $1,132.51
| Facility | | $641.48 | $797.18 | $1,132.51 |
- 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 |