- 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
- $1,823.63 / $2,790.88 / $13,909.00
| Facility | | $1,823.63 | $2,790.88 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $740.11 / $740.11 / $740.11
| Facility | AS | $740.11 | $740.11 | $740.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,868.82 / $3,565.13 / $4,809.47
| Facility | | $2,868.82 | $3,565.13 | $4,809.47 |
- 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 |