- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $8,023.32 / $21,899.37
| Facility | | $5,463.36 | $8,023.32 | $21,899.37 |
- 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
- $1,065.47 / $1,875.32 / $8,816.00
| Facility | | $1,065.47 | $1,875.32 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,568.44 / $1,568.44 / $1,568.44
| Facility | AS | $1,568.44 | $1,568.44 | $1,568.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,980.77 / $2,655.11 / $5,542.97
| Facility | | $1,980.77 | $2,655.11 | $5,542.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |