- 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
- $15,856.25 / $22,987.11 / $40,340.87
| Facility | | $15,856.25 | $22,987.11 | $40,340.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,768.96 / $3,002.68 / $4,287.52
| Facility | | $1,768.96 | $3,002.68 | $4,287.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $927.06 / $927.06 / $927.06
| Facility | AS | $927.06 | $927.06 | $927.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.52 / $4,457.03 / $5,958.41
| Facility | | $3,027.52 | $4,457.03 | $5,958.41 |
- 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 |