- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,983.72 / $9,631.16 / $20,928.72
| Facility | | $5,983.72 | $9,631.16 | $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
- $1,111.53 / $2,052.33 / $9,855.12
| Facility | | $1,111.53 | $2,052.33 | $9,855.12 |
- 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
- $1,752.48 / $2,353.55 / $5,383.60
| Facility | | $1,752.48 | $2,353.55 | $5,383.60 |
- 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 |