- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.00 / $5,463.36 / $13,841.56
| Facility | | $1,653.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,896.35 / $6,440.04 / $12,457.11
| Facility | | $4,896.35 | $6,440.04 | $12,457.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.61 / $920.90 / $8,816.00
| Facility | | $511.61 | $920.90 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $145.82 / $1,887.52 / $1,887.52
| Facility | AS | $145.82 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $1,383.11 / $6,616.19
| Facility | | $953.00 | $1,383.11 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |