- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $21,899.37
| Facility | | $4,241.22 | $10,431.19 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.82 / $1,875.28 / $9,696.00
| Facility | | $1,041.82 | $1,875.28 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $293.06 / $1,625.25 / $1,625.25
| Facility | AS | $293.06 | $1,625.25 | $1,625.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.76 / $2,614.37 / $3,705.20
| Facility | | $1,343.76 | $2,614.37 | $3,705.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $12,750.00
| Facility | | $6,777.00 | $8,220.00 | $12,750.00 |