- 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
- $6,416.80 / $9,302.56 / $16,325.39
| Facility | | $6,416.80 | $9,302.56 | $16,325.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,399.21 / $2,390.48 / $3,477.93
| Facility | | $1,399.21 | $2,390.48 | $3,477.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $726.79 / $726.79 / $726.79
| Facility | AS | $726.79 | $726.79 | $726.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.00 / $3,494.16 / $4,679.60
| Facility | | $2,511.00 | $3,494.16 | $4,679.60 |
- 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 |