- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.14 / $7,870.80 / $24,229.32
| Facility | | $2,367.14 | $7,870.80 | $24,229.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $622.74 / $622.74 / $622.74
| Facility | AS | $622.74 | $622.74 | $622.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,556.25 / $5,556.25 / $5,571.87
| Facility | | $5,556.25 | $5,556.25 | $5,571.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.81 / $1,989.20 / $2,406.92
| Facility | | $934.81 | $1,989.20 | $2,406.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,896.50 / $17,361.59 / $22,059.79
| Facility | | $12,896.50 | $17,361.59 | $22,059.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $11,800.00 / $29,092.00
| Facility | | $2,600.00 | $11,800.00 | $29,092.00 |