- 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
- $775.03 / $1,482.57 / $10,941.00
| Facility | | $775.03 | $1,482.57 | $10,941.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $363.47 / $363.47 / $363.47
| Facility | AS | $363.47 | $363.47 | $363.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.54 / $1,760.36 / $2,469.44
| Facility | | $1,416.54 | $1,760.36 | $2,469.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $9,696.00 / $15,622.00
| Facility | | $8,148.00 | $9,696.00 | $15,622.00 |