- 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
- $8,646.56 / $11,718.32 / $21,998.27
| Facility | | $8,646.56 | $11,718.32 | $21,998.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.77 / $1,455.84 / $7,819.36
| Facility | | $821.77 | $1,455.84 | $7,819.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $381.03 / $381.03 / $381.03
| Facility | AS | $381.03 | $381.03 | $381.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,499.00 / $1,867.31 / $2,675.78
| Facility | | $1,499.00 | $1,867.31 | $2,675.78 |
- 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 |