- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,431.19 / $20,928.72
| Facility | | $5,463.36 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,578.44 / $11,625.99 / $21,824.96
| Facility | | $8,578.44 | $11,625.99 | $21,824.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.27 / $1,216.83 / $9,719.69
| Facility | | $698.27 | $1,216.83 | $9,719.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,537.78 / $1,537.78 / $1,537.78
| Facility | AS | $1,537.78 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,287.95 / $1,726.50 / $5,275.65
| Facility | | $1,287.95 | $1,726.50 | $5,275.65 |
- 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 |