- 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
- $8,461.16 / $11,467.05 / $21,526.57
| Facility | | $8,461.16 | $11,467.05 | $21,526.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,020.67 / $3,075.99 / $7,856.00
| Facility | | $2,020.67 | $3,075.99 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $956.73 / $956.73 / $956.73
| Facility | AS | $956.73 | $956.73 | $956.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,553.19 / $4,436.35 / $6,395.70
| Facility | | $3,553.19 | $4,436.35 | $6,395.70 |
- 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 |