- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.59 / $8,477.27 / $19,276.96
| Facility | | $1,293.59 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,864.74 / $6,864.74 / $6,864.74
| Facility | | $6,864.74 | $6,864.74 | $6,864.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.82 / $1,144.19 / $9,496.00
| Facility | | $653.82 | $1,144.19 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $183.90 / $2,460.44 / $2,460.44
| Facility | AS | $183.90 | $2,460.44 | $2,460.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,637.01 / $8,894.12
| Facility | | $1,089.00 | $1,637.01 | $8,894.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |