- 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
- $1,017.47 / $1,760.69 / $9,496.00
| Facility | | $1,017.47 | $1,760.69 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $477.61 / $477.61 / $477.61
| Facility | AS | $477.61 | $477.61 | $477.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,726.00 / $2,296.19 / $3,097.30
| Facility | | $1,726.00 | $2,296.19 | $3,097.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |