- 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
- $14,877.26 / $21,567.85 / $37,850.17
| Facility | | $14,877.26 | $21,567.85 | $37,850.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.35 / $1,768.11 / $2,828.76
| Facility | | $1,010.35 | $1,768.11 | $2,828.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $521.66 / $521.66 / $521.66
| Facility | AS | $521.66 | $521.66 | $521.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.83 / $2,507.98 / $3,569.63
| Facility | | $2,034.83 | $2,507.98 | $3,569.63 |
- 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 |