- 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
- $2,240.88 / $3,252.59 / $13,909.00
| Facility | | $2,240.88 | $3,252.59 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $904.66 / $904.66 / $904.66
| Facility | AS | $904.66 | $904.66 | $904.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,474.00 / $4,382.21 / $5,897.96
| Facility | | $3,474.00 | $4,382.21 | $5,897.96 |
- 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 |