- 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
- $1,973.44 / $3,000.66 / $7,856.00
| Facility | | $1,973.44 | $3,000.66 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $934.18 / $934.18 / $934.18
| Facility | AS | $934.18 | $934.18 | $934.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,456.56 / $4,319.87 / $6,243.43
| Facility | | $3,456.56 | $4,319.87 | $6,243.43 |
- 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 |