- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $8,602.90 / $23,483.17
| Facility | | $4,241.22 | $8,602.90 | $23,483.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.66 / $2,356.60 / $9,696.00
| Facility | | $1,298.66 | $2,356.60 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $363.74 / $1,887.52 / $1,887.52
| Facility | AS | $363.74 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,616.36 / $3,543.08 / $6,616.19
| Facility | | $2,616.36 | $3,543.08 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |