- 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
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.60 / $913.16 / $7,090.16
| Facility | | $493.60 | $913.16 | $7,090.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $139.51 / $254.47 / $254.47
| Facility | AS | $139.51 | $254.47 | $254.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.71 / $1,223.42 / $1,706.09
| Facility | | $620.71 | $1,223.42 | $1,706.09 |
- 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 |