- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.00 / $5,463.36 / $15,392.08
| Facility | | $1,653.00 | $5,463.36 | $15,392.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,904.89 / $9,357.90 / $17,567.16
| Facility | | $6,904.89 | $9,357.90 | $17,567.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.41 / $700.72 / $8,632.00
| Facility | | $400.41 | $700.72 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $826.90 / $826.90 / $826.90
| Facility | AS | $826.90 | $826.90 | $826.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.03 / $1,167.49 / $2,865.45
| Facility | | $807.03 | $1,167.49 | $2,865.45 |
- 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 |