- 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
- $905.84 / $1,539.93 / $2,389.83
| Facility | | $905.84 | $1,539.93 | $2,389.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $458.54 / $458.54 / $458.54
| Facility | AS | $458.54 | $458.54 | $458.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.00 / $2,204.51 / $3,011.87
| Facility | | $1,613.00 | $2,204.51 | $3,011.87 |
- 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 |