- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,611.47 / $24,068.03
| Facility | | $5,463.36 | $11,611.47 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,584.12 / $13,894.28 / $24,383.56
| Facility | | $9,584.12 | $13,894.28 | $24,383.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.25 / $1,642.63 / $2,391.08
| Facility | | $966.25 | $1,642.63 | $2,391.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $497.90 / $497.90 / $497.90
| Facility | AS | $497.90 | $497.90 | $497.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.00 / $2,393.73 / $3,217.33
| Facility | | $1,732.00 | $2,393.73 | $3,217.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |