- 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
- $1,690.17 / $2,944.55 / $7,441.00
| Facility | | $1,690.17 | $2,944.55 | $7,441.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $472.53 / $858.79 / $858.79
| Facility | AS | $472.53 | $858.79 | $858.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,192.39 / $4,221.08 / $5,787.72
| Facility | | $2,192.39 | $4,221.08 | $5,787.72 |
- 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 |