- 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
- $7,218.81 / $10,465.26 / $18,365.84
| Facility | | $7,218.81 | $10,465.26 | $18,365.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.95 / $1,967.03 / $2,779.31
| Facility | | $1,148.95 | $1,967.03 | $2,779.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $600.67 / $600.67 / $600.67
| Facility | AS | $600.67 | $600.67 | $600.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,963.33 / $2,887.90 / $3,862.57
| Facility | | $1,963.33 | $2,887.90 | $3,862.57 |
- 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 |