- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $9,544.15 / $20,928.72
| Facility | | $4,241.22 | $9,544.15 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,094.34 / $5,385.17 / $10,416.66
| Facility | | $4,094.34 | $5,385.17 | $10,416.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.79 / $1,149.38 / $5,405.32
| Facility | | $656.79 | $1,149.38 | $5,405.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.06 / $849.00 / $849.00
| Facility | AS | $186.06 | $849.00 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.00 / $1,769.33 / $2,961.89
| Facility | | $1,296.00 | $1,769.33 | $2,961.89 |
- 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 |