- 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
- $3,612.87 / $5,084.96 / $13,909.00
| Facility | | $3,612.87 | $5,084.96 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,494.44 / $1,494.44 / $1,494.44
| Facility | AS | $1,494.44 | $1,494.44 | $1,494.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,509.00 / $7,184.81 / $9,757.27
| Facility | | $5,509.00 | $7,184.81 | $9,757.27 |
- 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 |