- 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
- $1,124.91 / $1,741.03 / $13,909.00
| Facility | | $1,124.91 | $1,741.03 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $456.42 / $456.42 / $456.42
| Facility | AS | $456.42 | $456.42 | $456.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.61 / $2,200.37 / $2,968.05
| Facility | | $1,770.61 | $2,200.37 | $2,968.05 |
- 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 |