- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,431.19 / $21,899.37
| Facility | | $5,463.36 | $10,431.19 | $21,899.37 |
- 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
- $1,174.58 / $1,994.87 / $7,856.00
| Facility | | $1,174.58 | $1,994.87 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $545.58 / $545.58 / $545.58
| Facility | AS | $545.58 | $545.58 | $545.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,066.00 / $2,644.10 / $3,669.56
| Facility | | $2,066.00 | $2,644.10 | $3,669.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |