- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,506.16 / $21,899.37
| Facility | | $5,463.36 | $10,506.16 | $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
- $1,304.15 / $2,270.96 / $7,856.00
| Facility | | $1,304.15 | $2,270.96 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $606.13 / $606.13 / $606.13
| Facility | AS | $606.13 | $606.13 | $606.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,353.00 / $3,072.33 / $4,104.10
| Facility | | $2,353.00 | $3,072.33 | $4,104.10 |
- 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 |