- 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
- $2,488.98 / $3,789.85 / $7,856.00
| Facility | | $2,488.98 | $3,789.85 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,179.57 / $1,179.57 / $1,179.57
| Facility | AS | $1,179.57 | $1,179.57 | $1,179.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,372.72 / $5,529.69 / $7,906.76
| Facility | | $4,372.72 | $5,529.69 | $7,906.76 |
- 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 |