- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,496.51 / $24,068.03
| Facility | | $5,463.36 | $11,496.51 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.60 / $13,313.50 / $24,992.84
| Facility | | $9,823.60 | $13,313.50 | $24,992.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,452.22 / $3,182.17 / $15,412.10
| Facility | | $1,452.22 | $3,182.17 | $15,412.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,105.03 / $2,105.03 / $2,105.03
| Facility | AS | $2,105.03 | $2,105.03 | $2,105.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,562.00 / $3,265.31 / $4,556.76
| Facility | | $2,562.00 | $3,265.31 | $4,556.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,470.36 / $9,696.00
| Facility | | $6,777.00 | $8,470.36 | $9,696.00 |