- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,394.71 / $8,698.86 / $21,899.37
| Facility | | $4,394.71 | $8,698.86 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,219.04 / $16,264.47 / $28,543.08
| Facility | | $11,219.04 | $16,264.47 | $28,543.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.68 / $1,617.86 / $3,076.06
| Facility | | $951.68 | $1,617.86 | $3,076.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,105.03 / $2,105.03 / $2,105.03
| Facility | AS | $2,105.03 | $2,105.03 | $2,105.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.00 / $2,364.62 / $3,352.71
| Facility | | $1,749.00 | $2,364.62 | $3,352.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $9,696.00 / $15,412.10
| Facility | | $6,777.00 | $9,696.00 | $15,412.10 |