- 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
- $1,190.68 / $2,024.16 / $2,945.28
| Facility | | $1,190.68 | $2,024.16 | $2,945.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $604.77 / $604.77 / $604.77
| Facility | AS | $604.77 | $604.77 | $604.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,180.00 / $2,907.54 / $4,124.43
| Facility | | $2,180.00 | $2,907.54 | $4,124.43 |
- 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 |