- 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
- $1,033.35 / $1,814.20 / $8,816.00
| Facility | | $1,033.35 | $1,814.20 | $8,816.00 |
- 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
- $1,753.00 / $2,367.73 / $3,265.11
| Facility | | $1,753.00 | $2,367.73 | $3,265.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,210.00 / $7,221.00 / $8,632.00
| Facility | | $6,210.00 | $7,221.00 | $8,632.00 |