- 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
- $2,702.70 / $4,113.64 / $7,856.00
| Facility | | $2,702.70 | $4,113.64 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,279.93 / $1,279.93 / $1,279.93
| Facility | AS | $1,279.93 | $1,279.93 | $1,279.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,752.32 / $5,934.91 / $8,575.23
| Facility | | $4,752.32 | $5,934.91 | $8,575.23 |
- 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 |