- 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
- $1,285.80 / $1,960.13 / $13,909.00
| Facility | | $1,285.80 | $1,960.13 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $521.36 / $521.36 / $521.36
| Facility | AS | $521.36 | $521.36 | $521.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,026.32 / $2,518.14 / $3,383.40
| Facility | | $2,026.32 | $2,518.14 | $3,383.40 |
- 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 |