- 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
- $4,896.35 / $6,635.81 / $12,457.11
| Facility | | $4,896.35 | $6,635.81 | $12,457.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.89 / $1,438.03 / $7,856.00
| Facility | | $889.89 | $1,438.03 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $417.36 / $417.36 / $417.36
| Facility | AS | $417.36 | $417.36 | $417.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,562.00 / $2,006.53 / $2,799.13
| Facility | | $1,562.00 | $2,006.53 | $2,799.13 |
- 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 |