- 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
- $11,018.89 / $14,492.85 / $28,033.86
| Facility | | $11,018.89 | $14,492.85 | $28,033.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.00 / $2,297.46 / $13,909.00
| Facility | | $1,525.00 | $2,297.46 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $618.09 / $618.09 / $618.09
| Facility | AS | $618.09 | $618.09 | $618.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,396.81 / $2,978.56 / $4,030.49
| Facility | | $2,396.81 | $2,978.56 | $4,030.49 |
- 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 |