- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.37 / $8,477.27 / $21,899.37
| Facility | | $3,932.37 | $8,477.27 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,474.97 / $6,064.74 / $11,385.07
| Facility | | $4,474.97 | $6,064.74 | $11,385.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.07 / $1,221.83 / $9,205.26
| Facility | | $643.07 | $1,221.83 | $9,205.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,678.13 / $1,678.13 / $1,678.13
| Facility | AS | $1,678.13 | $1,678.13 | $1,678.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.99 / $1,724.11 / $6,152.06
| Facility | | $1,289.99 | $1,724.11 | $6,152.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,765.35 / $7,221.00 / $8,816.00
| Facility | | $5,765.35 | $7,221.00 | $8,816.00 |