- 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
- $1,226.08 / $1,821.61 / $11,281.77
| Facility | | $1,226.08 | $1,821.61 | $11,281.77 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $495.17 / $495.17 / $495.17
| Facility | AS | $495.17 | $495.17 | $495.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,925.71 / $2,380.61 / $3,237.56
| Facility | | $1,925.71 | $2,380.61 | $3,237.56 |
- 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 |