- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.87 / $8,355.33 / $14,853.20
| Facility | | $3,315.87 | $8,355.33 | $14,853.20 |
- 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
- $536.64 / $992.78 / $9,696.00
| Facility | | $536.64 | $992.78 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,279.44 / $1,279.44 / $1,279.44
| Facility | AS | $1,279.44 | $1,279.44 | $1,279.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.00 / $1,331.15 / $1,785.68
| Facility | | $933.00 | $1,331.15 | $1,785.68 |
- 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 |