- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,330.03 / $24,068.03
| Facility | | $5,463.36 | $11,330.03 | $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
- $1,206.64 / $2,158.67 / $17,344.45
| Facility | | $1,206.64 | $2,158.67 | $17,344.45 |
- 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
- $2,175.00 / $2,828.34 / $3,797.95
| Facility | | $2,175.00 | $2,828.34 | $3,797.95 |
- 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 |