- 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
- $1,618.02 / $2,750.63 / $3,905.20
| Facility | | $1,618.02 | $2,750.63 | $3,905.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $817.91 / $817.91 / $817.91
| Facility | AS | $817.91 | $817.91 | $817.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,968.00 / $3,932.28 / $5,584.37
| Facility | | $2,968.00 | $3,932.28 | $5,584.37 |
- 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 |