- 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
- $1,133.92 / $1,984.36 / $7,306.25
| Facility | | $1,133.92 | $1,984.36 | $7,306.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $317.08 / $575.25 / $575.25
| Facility | AS | $317.08 | $575.25 | $575.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,468.16 / $2,832.87 / $3,875.19
| Facility | | $1,468.16 | $2,832.87 | $3,875.19 |
- 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 |