- 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
- $31,744.80 / $41,753.08 / $80,763.95
| Facility | | $31,744.80 | $41,753.08 | $80,763.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.73 / $1,867.83 / $13,909.00
| Facility | | $1,020.73 | $1,867.83 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $552.54 / $552.54 / $552.54
| Facility | AS | $552.54 | $552.54 | $552.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,378.28 / $2,656.46 / $3,506.76
| Facility | | $1,378.28 | $2,656.46 | $3,506.76 |
- 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 |