- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,506.16 / $21,899.37
| Facility | | $5,463.36 | $10,506.16 | $21,899.37 |
- 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
- $1,229.17 / $2,089.59 / $3,035.82
| Facility | | $1,229.17 | $2,089.59 | $3,035.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $631.41 / $631.41 / $631.41
| Facility | AS | $631.41 | $631.41 | $631.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,223.00 / $3,035.63 / $4,301.70
| Facility | | $2,223.00 | $3,035.63 | $4,301.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |