- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,623.41 / $18,620.87
| Facility | | $2,511.89 | $5,623.41 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,317.64 / $13,803.84
| Facility | | $2,344.23 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $17,378.01 / $22,387.21
| Facility | | $10,715.19 | $17,378.01 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,995.26 / $10,232.93
| Facility | | $1,096.48 | $1,995.26 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.12 / $1,905.46 / $1,905.46
| Facility | AS | $295.12 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,011.87 / $11,481.54
| Facility | | $2,884.03 | $5,011.87 | $11,481.54 |