- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,100.08 / $24,068.03
| Facility | | $5,463.36 | $11,100.08 | $24,068.03 |
- 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
- $1,521.65 / $2,758.72 / $8,757.16
| Facility | | $1,521.65 | $2,758.72 | $8,757.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,324.34 / $1,324.34 / $1,324.34
| Facility | AS | $1,324.34 | $1,324.34 | $1,324.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,163.00 / $2,891.54 / $4,092.09
| Facility | | $2,163.00 | $2,891.54 | $4,092.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,612.14 / $7,221.00 / $8,816.00
| Facility | | $4,612.14 | $7,221.00 | $8,816.00 |