- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,995.87 / $34,437.50
| Facility | | $5,463.36 | $11,995.87 | $34,437.50 |
- 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
- $1,530.28 / $2,601.48 / $4,367.38
| Facility | | $1,530.28 | $2,601.48 | $4,367.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $792.48 / $792.48 / $792.48
| Facility | AS | $792.48 | $792.48 | $792.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,762.00 / $3,810.02 / $5,401.87
| Facility | | $2,762.00 | $3,810.02 | $5,401.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,939.00 / $8,158.00 / $9,496.00
| Facility | | $6,939.00 | $8,158.00 | $9,496.00 |