- 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
- $7,349.44 / $9,666.52 / $18,698.16
| Facility | | $7,349.44 | $9,666.52 | $18,698.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.02 / $1,207.54 / $8,816.00
| Facility | | $690.02 | $1,207.54 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.04 / $1,955.22 / $1,955.22
| Facility | AS | $194.04 | $1,955.22 | $1,955.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,787.63 / $8,250.46
| Facility | | $1,285.00 | $1,787.63 | $8,250.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |