- 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
- $9,732.29 / $13,189.77 / $24,760.56
| Facility | | $9,732.29 | $13,189.77 | $24,760.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.99 / $1,566.08 / $7,856.00
| Facility | | $980.99 | $1,566.08 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $459.14 / $459.14 / $459.14
| Facility | AS | $459.14 | $459.14 | $459.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,605.00 / $2,207.41 / $3,032.61
| Facility | | $1,605.00 | $2,207.41 | $3,032.61 |
- 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 |