- 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
- $1,075.21 / $1,881.62 / $6,942.85
| Facility | | $1,075.21 | $1,881.62 | $6,942.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $302.12 / $546.94 / $546.94
| Facility | AS | $302.12 | $546.94 | $546.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.25 / $2,629.53 / $3,668.70
| Facility | | $1,380.25 | $2,629.53 | $3,668.70 |
- 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 |