- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $21,899.37
| Facility | | $4,241.22 | $10,431.19 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,478.61 / $2,661.50 / $9,696.00
| Facility | | $1,478.61 | $2,661.50 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $415.18 / $794.30 / $794.30
| Facility | AS | $415.18 | $794.30 | $794.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,919.84 / $3,728.85 / $5,262.17
| Facility | | $1,919.84 | $3,728.85 | $5,262.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |