- 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
- $918.27 / $1,589.58 / $10,941.00
| Facility | | $918.27 | $1,589.58 | $10,941.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $431.29 / $431.29 / $431.29
| Facility | AS | $431.29 | $431.29 | $431.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.00 / $2,073.48 / $2,851.71
| Facility | | $1,610.00 | $2,073.48 | $2,851.71 |
- 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 |