- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,774.45 / $10,088.31 / $23,483.17
| Facility | | $4,774.45 | $10,088.31 | $23,483.17 |
- 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
- $794.31 / $1,632.94 / $15,412.10
| Facility | | $794.31 | $1,632.94 | $15,412.10 |
- 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
- $1,488.95 / $1,990.66 / $8,854.25
| Facility | | $1,488.95 | $1,990.66 | $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 |