- 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
- $894.63 / $1,555.09 / $7,856.00
| Facility | | $894.63 | $1,555.09 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $420.09 / $420.09 / $420.09
| Facility | AS | $420.09 | $420.09 | $420.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,637.62 / $2,019.65 / $2,858.43
| Facility | | $1,637.62 | $2,019.65 | $2,858.43 |
- 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 |