- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,344.23 / $4,897.79
| Facility | | $1,202.26 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $25,703.96 / $32,359.37
| Facility | | $9,549.93 | $25,703.96 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,122.02 / $1,258.93
| Facility | | $1,071.52 | $1,122.02 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,949.84 / $1,949.84
| Facility | | $758.58 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Facility | AS | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,623.41 / $12,022.64
| Facility | | $1,023.29 | $5,623.41 | $12,022.64 |