- 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
- $491.49 / $909.26 / $7,039.01
| Facility | | $491.49 | $909.26 | $7,039.01 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.79 / $252.36 / $252.36
| Facility | AS | $138.79 | $252.36 | $252.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.91 / $1,213.25 / $1,683.12
| Facility | | $622.91 | $1,213.25 | $1,683.12 |
- 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 |