- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,605.88 / $20,928.72
| Facility | | $4,241.22 | $10,605.88 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,718.25 / $13,170.73 / $24,724.83
| Facility | | $9,718.25 | $13,170.73 | $24,724.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.47 / $2,065.28 / $13,336.93
| Facility | | $1,146.47 | $2,065.28 | $13,336.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,632.21 / $2,632.21 / $2,632.21
| Facility | AS | $2,632.21 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.83 / $2,414.83 / $8,854.25
| Facility | | $1,804.83 | $2,414.83 | $8,854.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $9,696.00 / $15,412.10
| Facility | | $6,777.00 | $9,696.00 | $15,412.10 |