- 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
- $6,416.80 / $9,302.56 / $16,325.39
| Facility | | $6,416.80 | $9,302.56 | $16,325.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.48 / $1,386.32 / $1,977.74
| Facility | | $815.48 | $1,386.32 | $1,977.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $421.75 / $421.75 / $421.75
| Facility | AS | $421.75 | $421.75 | $421.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,495.00 / $2,027.63 / $2,735.51
| Facility | | $1,495.00 | $2,027.63 | $2,735.51 |
- 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 |