- 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
- $9,195.75 / $12,462.61 / $23,395.49
| Facility | | $9,195.75 | $12,462.61 | $23,395.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,049.32 / $1,815.64 / $10,941.00
| Facility | | $1,049.32 | $1,815.64 | $10,941.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $493.20 / $493.20 / $493.20
| Facility | AS | $493.20 | $493.20 | $493.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,780.00 / $2,371.16 / $3,194.58
| Facility | | $1,780.00 | $2,371.16 | $3,194.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $9,696.00 / $15,622.00
| Facility | | $8,148.00 | $9,696.00 | $15,622.00 |