- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,431.19 / $23,483.17
| Facility | | $5,463.36 | $10,431.19 | $23,483.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,584.12 / $13,894.28 / $24,383.56
| Facility | | $9,584.12 | $13,894.28 | $24,383.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.41 / $1,401.70 / $2,039.86
| Facility | | $829.41 | $1,401.70 | $2,039.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $428.11 / $428.11 / $428.11
| Facility | AS | $428.11 | $428.11 | $428.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $2,058.21 / $2,800.42
| Facility | | $1,481.00 | $2,058.21 | $2,800.42 |
- 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 |