- 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
- $7,218.81 / $10,465.26 / $18,365.84
| Facility | | $7,218.81 | $10,465.26 | $18,365.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.66 / $1,536.22 / $2,225.28
| Facility | | $903.66 | $1,536.22 | $2,225.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $453.09 / $453.09 / $453.09
| Facility | AS | $453.09 | $453.09 | $453.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $2,178.29 / $3,076.35
| Facility | | $1,643.00 | $2,178.29 | $3,076.35 |
- 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 |