- 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
- $3,044.79 / $4,197.22 / $13,909.00
| Facility | | $3,044.79 | $4,197.22 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,228.01 / $1,228.01 / $1,228.01
| Facility | AS | $1,228.01 | $1,228.01 | $1,228.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.77 / $5,903.89 / $8,018.39
| Facility | | $4,265.77 | $5,903.89 | $8,018.39 |
- 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 |