- 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
- $1,354.38 / $2,002.11 / $12,362.94
| Facility | | $1,354.38 | $2,002.11 | $12,362.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $544.05 / $544.05 / $544.05
| Facility | AS | $544.05 | $544.05 | $544.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,109.15 / $2,615.69 / $3,561.07
| Facility | | $2,109.15 | $2,615.69 | $3,561.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,126.00 / $4,317.00 / $7,856.00
| Facility | | $3,126.00 | $4,317.00 | $7,856.00 |