- 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
- $3,016.61 / $4,144.09 / $13,909.00
| Facility | | $3,016.61 | $4,144.09 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,216.66 / $1,216.66 / $1,216.66
| Facility | AS | $1,216.66 | $1,216.66 | $1,216.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,315.00 / $5,849.30 / $7,950.53
| Facility | | $4,315.00 | $5,849.30 | $7,950.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,126.00 / $4,317.00 / $7,856.00
| Facility | | $3,126.00 | $4,317.00 | $7,856.00 |