- 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
- $2,903.10 / $4,642.55 / $13,909.00
| Facility | | $2,903.10 | $4,642.55 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,370.61 / $1,370.61 / $1,370.61
| Facility | AS | $1,370.61 | $1,370.61 | $1,370.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,762.00 / $6,589.46 / $9,020.04
| Facility | | $4,762.00 | $6,589.46 | $9,020.04 |
- 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 |