- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,668.15 / $24,068.03
| Facility | | $5,463.36 | $11,668.15 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,461.16 / $11,467.05 / $21,526.57
| Facility | | $8,461.16 | $11,467.05 | $21,526.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.04 / $2,177.44 / $9,666.00
| Facility | | $1,275.04 | $2,177.44 | $9,666.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $597.35 / $597.35 / $597.35
| Facility | AS | $597.35 | $597.35 | $597.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,306.27 / $2,871.88 / $4,036.82
| Facility | | $2,306.27 | $2,871.88 | $4,036.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,939.00 / $8,158.00 / $9,496.00
| Facility | | $6,939.00 | $8,158.00 | $9,496.00 |