- 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
- $10,176.85 / $13,792.24 / $25,891.56
| Facility | | $10,176.85 | $13,792.24 | $25,891.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.48 / $1,728.74 / $7,856.00
| Facility | | $1,128.48 | $1,728.74 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $531.50 / $531.50 / $531.50
| Facility | AS | $531.50 | $531.50 | $531.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,996.88 / $2,481.56 / $3,539.36
| Facility | | $1,996.88 | $2,481.56 | $3,539.36 |
- 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 |