- 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
- $1,197.91 / $1,855.57 / $11,028.06
| Facility | | $1,197.91 | $1,855.57 | $11,028.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $485.03 / $485.03 / $485.03
| Facility | AS | $485.03 | $485.03 | $485.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,881.81 / $2,338.56 / $3,167.56
| Facility | | $1,881.81 | $2,338.56 | $3,167.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |