- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $8,477.27 / $19,276.96
| Facility | | $4,382.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.41 / $9,976.87 / $19,298.50
| Facility | | $7,585.41 | $9,976.87 | $19,298.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.29 / $1,007.35 / $9,696.00
| Facility | | $657.29 | $1,007.35 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,314.53 / $1,314.53 / $1,314.53
| Facility | AS | $1,314.53 | $1,314.53 | $1,314.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.58 / $1,281.97 / $1,731.27
| Facility | | $1,031.58 | $1,281.97 | $1,731.27 |
- 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 |