- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,876.51 / $6,091.00 / $10,295.41
| Facility | | $1,876.51 | $6,091.00 | $10,295.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $4,903.56 / $8,070.83
| Facility | | $1,310.70 | $4,903.56 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,374.52 / $5,374.52 / $5,374.52
| Facility | | $5,374.52 | $5,374.52 | $5,374.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.67 / $1,294.15 / $7,168.00
| Facility | | $931.67 | $1,294.15 | $7,168.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $242.85 / $1,568.44 / $1,568.44
| Facility | AS | $242.85 | $1,568.44 | $1,568.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,759.00 / $6,477.00 / $9,010.00
| Facility | | $4,759.00 | $6,477.00 | $9,010.00 |