- 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
- $1,161.60 / $1,594.37 / $13,909.00
| Facility | | $1,161.60 | $1,594.37 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $468.83 / $468.83 / $468.83
| Facility | AS | $468.83 | $468.83 | $468.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.41 / $2,272.19 / $3,208.79
| Facility | | $1,828.41 | $2,272.19 | $3,208.79 |
- 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 |