- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,906.94 / $7,769.24 / $15,028.22
| Facility | | $5,906.94 | $7,769.24 | $15,028.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,916.50 / $2,916.50 / $2,916.50
| Facility | | $2,916.50 | $2,916.50 | $2,916.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.60 / $1,336.68 / $7,276.41
| Facility | | $742.60 | $1,336.68 | $7,276.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $210.38 / $1,045.32 / $1,045.32
| Facility | AS | $210.38 | $1,045.32 | $1,045.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.59 / $2,036.21 / $3,701.41
| Facility | | $1,222.59 | $2,036.21 | $3,701.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |