- 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
- $5,118.27 / $6,731.93 / $13,021.72
| Facility | | $5,118.27 | $6,731.93 | $13,021.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.25 / $995.50 / $7,984.00
| Facility | | $626.25 | $995.50 | $7,984.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $757.42 / $757.42 / $757.42
| Facility | AS | $757.42 | $757.42 | $757.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.03 / $1,224.11 / $1,651.63
| Facility | | $985.03 | $1,224.11 | $1,651.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |