- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,431.19 / $20,928.72
| Facility | | $5,463.36 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,998.88 / $6,774.77 / $12,717.97
| Facility | | $4,998.88 | $6,774.77 | $12,717.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.39 / $779.67 / $7,772.00
| Facility | | $455.39 | $779.67 | $7,772.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $889.94 / $889.94 / $889.94
| Facility | AS | $889.94 | $889.94 | $889.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.84 / $1,112.92 / $3,145.09
| Facility | | $828.84 | $1,112.92 | $3,145.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,356.00 / $7,772.00
| Facility | | $3,711.00 | $5,356.00 | $7,772.00 |