- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,005.00 / $10,563.53 / $20,928.72
| Facility | | $5,005.00 | $10,563.53 | $20,928.72 |
- 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
- $666.65 / $1,382.52 / $7,984.00
| Facility | | $666.65 | $1,382.52 | $7,984.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $757.42 / $757.42 / $757.42
| Facility | AS | $757.42 | $757.42 | $757.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.35 / $1,815.86 / $2,438.14
| Facility | | $975.35 | $1,815.86 | $2,438.14 |
- 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 |