- 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
- $887.31 / $1,351.58 / $7,856.00
| Facility | | $887.31 | $1,351.58 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $417.06 / $417.06 / $417.06
| Facility | AS | $417.06 | $417.06 | $417.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.00 / $1,944.42 / $2,629.79
| Facility | | $1,527.00 | $1,944.42 | $2,629.79 |
- 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 |