- 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
- $9,195.75 / $12,094.93 / $23,395.49
| Facility | | $9,195.75 | $12,094.93 | $23,395.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.34 / $1,105.08 / $8,163.00
| Facility | | $597.34 | $1,105.08 | $8,163.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $166.38 / $307.30 / $307.30
| Facility | AS | $166.38 | $307.30 | $307.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.40 / $1,492.02 / $2,091.92
| Facility | | $785.40 | $1,492.02 | $2,091.92 |
- 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 |