- 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
- $2,159.25 / $3,283.25 / $7,856.00
| Facility | | $2,159.25 | $3,283.25 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,020.61 / $1,020.61 / $1,020.61
| Facility | AS | $1,020.61 | $1,020.61 | $1,020.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,794.81 / $4,715.88 / $6,732.25
| Facility | | $3,794.81 | $4,715.88 | $6,732.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,126.00 / $4,317.00 / $7,856.00
| Facility | | $3,126.00 | $4,317.00 | $7,856.00 |