- 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
- $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
- $1,548.18 / $2,631.91 / $3,729.45
| Facility | | $1,548.18 | $2,631.91 | $3,729.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $787.03 / $787.03 / $787.03
| Facility | AS | $787.03 | $787.03 | $787.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,814.00 / $3,783.80 / $5,348.10
| Facility | | $2,814.00 | $3,783.80 | $5,348.10 |
- 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 |