- 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
- $7,838.93 / $11,364.26 / $19,943.52
| Facility | | $7,838.93 | $11,364.26 | $19,943.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.49 / $1,083.73 / $1,927.08
| Facility | | $637.49 | $1,083.73 | $1,927.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,704.89 / $1,704.89 / $1,704.89
| Facility | AS | $1,704.89 | $1,704.89 | $1,704.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.47 / $1,612.91 / $6,141.94
| Facility | | $1,282.47 | $1,612.91 | $6,141.94 |
- 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 |