- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,506.16 / $21,899.37
| Facility | | $5,463.36 | $10,506.16 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,193.47 / $8,978.79 / $15,757.21
| Facility | | $6,193.47 | $8,978.79 | $15,757.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.17 / $1,673.09 / $3,123.21
| Facility | | $984.17 | $1,673.09 | $3,123.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,568.44 / $1,568.44 / $1,568.44
| Facility | AS | $1,568.44 | $1,568.44 | $1,568.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.50 / $2,430.46 / $5,251.23
| Facility | | $1,661.50 | $2,430.46 | $5,251.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,612.14 / $7,221.00 / $8,816.00
| Facility | | $4,612.14 | $7,221.00 | $8,816.00 |