- 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
- $5,489.78 / $7,958.64 / $13,966.90
| Facility | | $5,489.78 | $7,958.64 | $13,966.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $983.65 / $1,662.37 / $2,368.98
| Facility | | $983.65 | $1,662.37 | $2,368.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $492.14 / $492.14 / $492.14
| Facility | AS | $492.14 | $492.14 | $492.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,715.00 / $2,366.06 / $3,256.17
| Facility | | $1,715.00 | $2,366.06 | $3,256.17 |
- 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 |