- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,047.43 / $7,161.40 / $20,932.43
| Facility | | $3,047.43 | $7,161.40 | $20,932.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,990.74 / $13,540.02 / $25,418.08
| Facility | | $9,990.74 | $13,540.02 | $25,418.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,139.30 / $2,039.68 / $12,960.17
| Facility | | $1,139.30 | $2,039.68 | $12,960.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,632.21 / $2,632.21 / $2,632.21
| Facility | AS | $2,632.21 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.80 / $2,399.50 / $8,854.25
| Facility | | $1,794.80 | $2,399.50 | $8,854.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |