- 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
- $1,355.98 / $2,091.78 / $12,535.65
| Facility | | $1,355.98 | $2,091.78 | $12,535.65 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $549.66 / $549.66 / $549.66
| Facility | AS | $549.66 | $549.66 | $549.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,138.28 / $2,657.28 / $3,567.32
| Facility | | $2,138.28 | $2,657.28 | $3,567.32 |
- 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 |