- 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
- $4,896.35 / $6,440.04 / $12,457.11
| Facility | | $4,896.35 | $6,440.04 | $12,457.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.20 / $825.88 / $4,097.59
| Facility | | $452.20 | $825.88 | $4,097.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.19 / $230.71 / $230.71
| Facility | AS | $126.19 | $230.71 | $230.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.49 / $1,127.58 / $1,569.46
| Facility | | $581.49 | $1,127.58 | $1,569.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |