- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $12,036.14 / $24,068.03
| Facility | | $5,463.36 | $12,036.14 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,718.25 / $13,170.73 / $24,724.83
| Facility | | $9,718.25 | $13,170.73 | $24,724.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $999.27 / $1,763.07 / $8,632.00
| Facility | | $999.27 | $1,763.07 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $464.74 / $464.74 / $464.74
| Facility | AS | $464.74 | $464.74 | $464.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,679.00 / $2,234.34 / $3,134.75
| Facility | | $1,679.00 | $2,234.34 | $3,134.75 |
- 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 |