- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.22 / $8,477.27 / $20,928.72
| Facility | | $1,769.22 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.83 / $15,476.59 / $29,936.73
| Facility | | $11,766.83 | $15,476.59 | $29,936.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.22 / $3,096.14 / $4,856.64
| Facility | | $1,769.22 | $3,096.14 | $4,856.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $497.05 / $961.12 / $961.12
| Facility | AS | $497.05 | $961.12 | $961.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,293.96 / $4,449.35 / $6,335.88
| Facility | | $2,293.96 | $4,449.35 | $6,335.88 |
- 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 |