- 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
- $9,584.12 / $13,894.28 / $24,383.56
| Facility | | $9,584.12 | $13,894.28 | $24,383.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.58 / $1,783.93 / $2,578.98
| Facility | | $1,055.58 | $1,783.93 | $2,578.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $539.07 / $539.07 / $539.07
| Facility | AS | $539.07 | $539.07 | $539.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.00 / $2,591.69 / $3,491.88
| Facility | | $1,850.00 | $2,591.69 | $3,491.88 |
- 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 |