- 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
- $1,727.52 / $2,919.51 / $4,406.00
| Facility | | $1,727.52 | $2,919.51 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $895.72 / $895.72 / $895.72
| Facility | AS | $895.72 | $895.72 | $895.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,077.00 / $4,306.37 / $5,881.78
| Facility | | $3,077.00 | $4,306.37 | $5,881.78 |
- 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 |