- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,309.57 / $15,488.17
| Facility | | $2,089.30 | $6,309.57 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,570.88 / $8,317.64
| Facility | | $1,737.80 | $4,570.88 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $25,118.86
| Facility | | $18,620.87 | $18,620.87 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,187.76 / $4,365.16
| Facility | | $1,698.24 | $2,187.76 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $478.63 / $478.63 / $891.25
| Facility | AS | $478.63 | $478.63 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,089.30 / $5,248.07
| Facility | | $831.76 | $2,089.30 | $5,248.07 |