- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.34 / $9,544.15 / $20,928.72
| Facility | | $5,032.34 | $9,544.15 | $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
- $734.43 / $1,178.47 / $9,696.00
| Facility | | $734.43 | $1,178.47 | $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
- $1,155.66 / $1,659.66 / $5,718.15
| Facility | | $1,155.66 | $1,659.66 | $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 |