- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,431.19 / $20,928.72
| Facility | | $5,463.36 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,838.93 / $11,364.26 / $19,943.52
| Facility | | $7,838.93 | $11,364.26 | $19,943.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.61 / $958.14 / $1,573.57
| Facility | | $563.61 | $958.14 | $1,573.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $905.99 / $905.99 / $905.99
| Facility | AS | $905.99 | $905.99 | $905.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.21 / $1,528.92 / $3,033.31
| Facility | | $1,086.21 | $1,528.92 | $3,033.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.07 / $5,341.00 / $8,632.00
| Facility | | $4,393.07 | $5,341.00 | $8,632.00 |