- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,764.85 / $8,477.27 / $20,928.72
| Facility | | $1,764.85 | $8,477.27 | $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
- $1,764.85 / $3,088.49 / $10,108.50
| Facility | | $1,764.85 | $3,088.49 | $10,108.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $881.80 / $881.80 / $881.80
| Facility | AS | $881.80 | $881.80 | $881.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,554.41 / $4,313.22 / $5,982.74
| Facility | | $3,554.41 | $4,313.22 | $5,982.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |