- 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
- $1,412.11 / $2,400.59 / $3,523.37
| Facility | | $1,412.11 | $2,400.59 | $3,523.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $720.28 / $720.28 / $720.28
| Facility | AS | $720.28 | $720.28 | $720.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,590.00 / $3,462.86 / $4,928.62
| Facility | | $2,590.00 | $3,462.86 | $4,928.62 |
- 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 |