- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $9,819.78 / $21,899.37
| Facility | | $5,463.36 | $9,819.78 | $21,899.37 |
- 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
- $732.48 / $1,303.40 / $8,632.00
| Facility | | $732.48 | $1,303.40 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $900.13 / $900.13 / $900.13
| Facility | AS | $900.13 | $900.13 | $900.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.11 / $1,837.93 / $3,093.19
| Facility | | $1,379.11 | $1,837.93 | $3,093.19 |
- 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 |