- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,506.16 / $21,899.37
| Facility | | $5,463.36 | $10,506.16 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.41 / $9,976.87 / $19,298.50
| Facility | | $7,585.41 | $9,976.87 | $19,298.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.48 / $1,652.36 / $9,696.00
| Facility | | $1,068.48 | $1,652.36 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $432.80 / $432.80 / $432.80
| Facility | AS | $432.80 | $432.80 | $432.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.86 / $2,091.32 / $2,811.53
| Facility | | $1,682.86 | $2,091.32 | $2,811.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |