- 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
- $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
- $901.24 / $1,577.17 / $6,967.74
| Facility | | $901.24 | $1,577.17 | $6,967.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.88 / $456.72 / $456.72
| Facility | AS | $251.88 | $456.72 | $456.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.33 / $2,251.08 / $3,080.54
| Facility | | $1,157.33 | $2,251.08 | $3,080.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |