- 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
- $9,195.75 / $12,462.61 / $23,395.49
| Facility | | $9,195.75 | $12,462.61 | $23,395.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.28 / $1,345.53 / $7,856.00
| Facility | | $771.28 | $1,345.53 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $362.41 / $362.41 / $362.41
| Facility | AS | $362.41 | $362.41 | $362.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.96 / $1,742.36 / $2,457.96
| Facility | | $1,408.96 | $1,742.36 | $2,457.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |