- 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
- $20,988.56 / $27,605.70 / $53,398.33
| Facility | | $20,988.56 | $27,605.70 | $53,398.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,512.70 / $2,151.38 / $13,909.00
| Facility | | $1,512.70 | $2,151.38 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $611.13 / $611.13 / $611.13
| Facility | AS | $611.13 | $611.13 | $611.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,356.00 / $2,938.12 / $3,977.68
| Facility | | $2,356.00 | $2,938.12 | $3,977.68 |
- 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 |