- 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
- $1,414.97 / $2,132.13 / $13,009.05
| Facility | | $1,414.97 | $2,132.13 | $13,009.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $570.10 / $570.10 / $570.10
| Facility | AS | $570.10 | $570.10 | $570.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,221.85 / $2,761.14 / $3,697.15
| Facility | | $2,221.85 | $2,761.14 | $3,697.15 |
- 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 |