- 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
- $18,424.50 / $24,233.27 / $46,874.97
| Facility | | $18,424.50 | $24,233.27 | $46,874.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.02 / $1,389.54 / $4,406.00
| Facility | | $794.02 | $1,389.54 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $408.43 / $408.43 / $408.43
| Facility | AS | $408.43 | $408.43 | $408.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.28 / $1,971.30 / $2,814.61
| Facility | | $1,586.28 | $1,971.30 | $2,814.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |