- 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
- $8,383.91 / $11,027.13 / $21,330.03
| Facility | | $8,383.91 | $11,027.13 | $21,330.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.72 / $1,807.41 / $13,909.00
| Facility | | $1,236.72 | $1,807.41 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $501.38 / $501.38 / $501.38
| Facility | AS | $501.38 | $501.38 | $501.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,933.00 / $2,416.64 / $3,262.89
| Facility | | $1,933.00 | $2,416.64 | $3,262.89 |
- 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 |