- 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
- $11,219.04 / $16,264.47 / $28,543.08
| Facility | | $11,219.04 | $16,264.47 | $28,543.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.31 / $1,976.29 / $2,903.47
| Facility | | $1,129.31 | $1,976.29 | $2,903.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $583.41 / $583.41 / $583.41
| Facility | AS | $583.41 | $583.41 | $583.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,996.00 / $2,804.92 / $3,985.71
| Facility | | $1,996.00 | $2,804.92 | $3,985.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |