- 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
- $7,585.41 / $9,976.87 / $19,298.50
| Facility | | $7,585.41 | $9,976.87 | $19,298.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.38 / $1,601.03 / $9,696.00
| Facility | | $1,070.38 | $1,601.03 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,314.53 / $1,314.53 / $1,314.53
| Facility | AS | $1,314.53 | $1,314.53 | $1,314.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.36 / $2,090.69 / $2,829.19
| Facility | | $1,682.36 | $2,090.69 | $2,829.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,729.16 / $8,002.25 / $9,496.00
| Facility | | $6,729.16 | $8,002.25 | $9,496.00 |