- 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
- $935.20 / $1,589.84 / $2,524.71
| Facility | | $935.20 | $1,589.84 | $2,524.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $479.42 / $479.42 / $479.42
| Facility | AS | $479.42 | $479.42 | $479.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $2,304.92 / $3,154.48
| Facility | | $1,689.00 | $2,304.92 | $3,154.48 |
- 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 |