- 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
- $7,585.41 / $9,976.87 / $19,298.50
| Facility | | $7,585.41 | $9,976.87 | $19,298.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.23 / $1,605.96 / $9,696.00
| Facility | | $1,039.23 | $1,605.96 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,314.53 / $1,314.53 / $1,314.53
| Facility | AS | $1,314.53 | $1,314.53 | $1,314.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,637.41 / $2,034.84 / $2,741.39
| Facility | | $1,637.41 | $2,034.84 | $2,741.39 |
- 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 |