- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.37 / $7,943.37 / $20,928.72
| Facility | | $3,932.37 | $7,943.37 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,198.33 / $7,045.08 / $13,225.41
| Facility | | $5,198.33 | $7,045.08 | $13,225.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.70 / $1,750.58 / $8,816.00
| Facility | | $860.70 | $1,750.58 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,196.53 / $1,196.53 / $1,196.53
| Facility | AS | $1,196.53 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.89 / $1,785.80 / $4,164.35
| Facility | | $1,305.89 | $1,785.80 | $4,164.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |