- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $8,355.33 / $19,276.96
| Facility | | $4,241.22 | $8,355.33 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,099.31 / $6,706.99 / $12,973.48
| Facility | | $5,099.31 | $6,706.99 | $12,973.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.00 / $2,438.96 / $10,864.34
| Facility | | $1,062.00 | $2,438.96 | $10,864.34 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,442.13 / $1,442.13 / $1,442.13
| Facility | AS | $1,442.13 | $1,442.13 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.79 / $2,676.36 / $5,096.56
| Facility | | $1,366.79 | $2,676.36 | $5,096.56 |
- 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 |