- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,752.78 / $9,185.68 / $20,928.72
| Facility | | $3,752.78 | $9,185.68 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,522.03 / $5,947.70 / $11,504.78
| Facility | | $4,522.03 | $5,947.70 | $11,504.78 |
- 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
- $455.29 / $819.52 / $5,341.00
| Facility | | $455.29 | $819.52 | $5,341.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.55 / $849.00 / $849.00
| Facility | AS | $128.55 | $849.00 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.46 / $1,285.00 / $2,961.89
| Facility | | $919.46 | $1,285.00 | $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 |