- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,752.78 / $9,008.08 / $20,928.72
| Facility | | $3,752.78 | $9,008.08 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,335.87 / $4,387.57 / $8,486.99
| Facility | | $3,335.87 | $4,387.57 | $8,486.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.09 / $473.27 / $8,632.00
| Facility | | $249.09 | $473.27 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $78.72 / $1,887.52 / $1,887.52
| Facility | AS | $78.72 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.93 / $814.35 / $6,616.19
| Facility | | $498.93 | $814.35 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |