- 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
- $7,218.81 / $10,465.26 / $18,365.84
| Facility | | $7,218.81 | $10,465.26 | $18,365.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.24 / $1,568.73 / $2,283.00
| Facility | | $928.24 | $1,568.73 | $2,283.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $473.22 / $473.22 / $473.22
| Facility | AS | $473.22 | $473.22 | $473.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.00 / $2,275.09 / $3,158.31
| Facility | | $1,665.00 | $2,275.09 | $3,158.31 |
- 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 |