- 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
- $1,428.13 / $2,499.23 / $8,220.00
| Facility | | $1,428.13 | $2,499.23 | $8,220.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $402.80 / $752.22 / $752.22
| Facility | AS | $402.80 | $752.22 | $752.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,823.13 / $3,584.67 / $5,012.89
| Facility | | $1,823.13 | $3,584.67 | $5,012.89 |
- 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 |