- 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
- $5,906.94 / $8,005.42 / $15,028.22
| Facility | | $5,906.94 | $8,005.42 | $15,028.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.94 / $970.54 / $8,632.00
| Facility | | $587.94 | $970.54 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,045.32 / $1,045.32 / $1,045.32
| Facility | AS | $1,045.32 | $1,045.32 | $1,045.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.51 / $1,402.70 / $3,701.41
| Facility | | $1,036.51 | $1,402.70 | $3,701.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |