- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $23,483.17
| Facility | | $4,241.22 | $10,431.19 | $23,483.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.40 / $10,296.48 / $19,916.72
| Facility | | $7,828.40 | $10,296.48 | $19,916.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.22 / $2,256.14 / $8,220.00
| Facility | | $1,289.22 | $2,256.14 | $8,220.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $364.79 / $686.82 / $686.82
| Facility | AS | $364.79 | $686.82 | $686.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,630.98 / $3,200.85 / $4,393.67
| Facility | | $1,630.98 | $3,200.85 | $4,393.67 |
- 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 |