- 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
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,487.14 / $2,589.38 / $7,441.00
| Facility | | $1,487.14 | $2,589.38 | $7,441.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $416.83 / $756.76 / $756.76
| Facility | AS | $416.83 | $756.76 | $756.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,929.34 / $3,719.65 / $5,092.16
| Facility | | $1,929.34 | $3,719.65 | $5,092.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.70 / $6,178.00 / $8,816.00
| Facility | | $1,172.70 | $6,178.00 | $8,816.00 |