- 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
- $2,635.51 / $3,822.10 / $13,909.00
| Facility | | $2,635.51 | $3,822.10 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,064.82 / $1,064.82 / $1,064.82
| Facility | AS | $1,064.82 | $1,064.82 | $1,064.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.64 / $5,153.10 / $6,938.24
| Facility | | $4,146.64 | $5,153.10 | $6,938.24 |
- 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 |