- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,563.53 / $20,928.72
| Facility | | $5,463.36 | $10,563.53 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.13 / $9,096.60 / $17,595.75
| Facility | | $6,916.13 | $9,096.60 | $17,595.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.31 / $1,302.89 / $9,696.00
| Facility | | $874.31 | $1,302.89 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,618.01 / $1,618.01 / $1,618.01
| Facility | AS | $1,618.01 | $1,618.01 | $1,618.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.80 / $1,860.14 / $5,718.15
| Facility | | $1,202.80 | $1,860.14 | $5,718.15 |
- 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 |