- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $6,732.07 / $16,762.57
| Facility | | $4,241.22 | $6,732.07 | $16,762.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,416.80 / $9,302.56 / $16,325.39
| Facility | | $6,416.80 | $9,302.56 | $16,325.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.83 / $514.22 / $7,441.00
| Facility | | $293.83 | $514.22 | $7,441.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,537.78 / $1,537.78 / $1,537.78
| Facility | AS | $1,537.78 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.79 / $797.46 / $5,090.60
| Facility | | $580.79 | $797.46 | $5,090.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |