- 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
- $1,816.30 / $2,752.08 / $13,909.00
| Facility | | $1,816.30 | $2,752.08 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $735.86 / $735.86 / $735.86
| Facility | AS | $735.86 | $735.86 | $735.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,854.79 / $3,547.70 / $4,800.62
| Facility | | $2,854.79 | $3,547.70 | $4,800.62 |
- 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 |