- 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
- $1,176.56 / $1,813.32 / $10,869.93
| Facility | | $1,176.56 | $1,813.32 | $10,869.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $475.34 / $475.34 / $475.34
| Facility | AS | $475.34 | $475.34 | $475.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,846.79 / $2,295.04 / $3,106.92
| Facility | | $1,846.79 | $2,295.04 | $3,106.92 |
- 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 |