- 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
- $1,130.82 / $2,010.26 / $2,829.30
| Facility | | $1,130.82 | $2,010.26 | $2,829.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $614.61 / $614.61 / $614.61
| Facility | AS | $614.61 | $614.61 | $614.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,999.10 / $2,954.86 / $3,934.52
| Facility | | $1,999.10 | $2,954.86 | $3,934.52 |
- 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 |