- 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
- $9,506.16 / $12,883.29 / $24,185.23
| Facility | | $9,506.16 | $12,883.29 | $24,185.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,538.80 / $2,478.04 / $7,856.00
| Facility | | $1,538.80 | $2,478.04 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $713.16 / $713.16 / $713.16
| Facility | AS | $713.16 | $713.16 | $713.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,557.00 / $3,428.64 / $4,685.58
| Facility | | $2,557.00 | $3,428.64 | $4,685.58 |
- 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 |