- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $21,899.37
| Facility | | $4,241.22 | $10,431.19 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.43 / $2,338.75 / $8,220.00
| Facility | | $1,336.43 | $2,338.75 | $8,220.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $377.10 / $701.35 / $701.35
| Facility | AS | $377.10 | $701.35 | $701.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,699.18 / $3,331.72 / $4,675.04
| Facility | | $1,699.18 | $3,331.72 | $4,675.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |