- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $14,454.40 / $14,454.40
| Facility | | $9,120.11 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,964.78 / $30,199.52
| Facility | | $8,912.51 | $10,964.78 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $398.11 / $457.09
| Facility | | $389.05 | $398.11 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $776.25
| Facility | | $407.38 | $588.84 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | AS | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $10,000.00 / $16,218.10
| Facility | | $2,511.89 | $10,000.00 | $16,218.10 |