- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,454.75 / $8,272.95 / $16,677.12
| Facility | | $5,454.75 | $8,272.95 | $16,677.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,949.60 / $11,258.34 / $19,729.47
| Facility | | $4,949.60 | $11,258.34 | $19,729.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $924.41 / $2,345.00 / $5,740.31
| Facility | | $924.41 | $2,345.00 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.20 / $92.20 / $92.20
| Facility | AS | $92.20 | $92.20 | $92.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.27 / $1,078.00 / $1,766.13
| Facility | | $909.27 | $1,078.00 | $1,766.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $136.12 / $150.91 / $262.18
| Facility | AS | $136.12 | $150.91 | $262.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |