- 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
- $859.22 / $1,485.08 / $7,856.00
| Facility | | $859.22 | $1,485.08 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $403.43 / $403.43 / $403.43
| Facility | AS | $403.43 | $403.43 | $403.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,572.34 / $1,953.97 / $2,740.57
| Facility | | $1,572.34 | $1,953.97 | $2,740.57 |
- 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 |