- 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
- $6,916.13 / $9,096.60 / $17,595.75
| Facility | | $6,916.13 | $9,096.60 | $17,595.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.38 / $1,325.35 / $9,696.00
| Facility | | $889.38 | $1,325.35 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,618.01 / $1,618.01 / $1,618.01
| Facility | AS | $1,618.01 | $1,618.01 | $1,618.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,825.80 / $5,718.15
| Facility | | $1,285.00 | $1,825.80 | $5,718.15 |
- 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 |