- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- 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
- $727.77 / $1,273.59 / $8,220.00
| Facility | | $727.77 | $1,273.59 | $8,220.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $205.34 / $381.64 / $381.64
| Facility | AS | $205.34 | $381.64 | $381.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.39 / $1,832.44 / $2,547.64
| Facility | | $928.39 | $1,832.44 | $2,547.64 |
- 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 |