- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.00 / $5,463.36 / $13,841.56
| Facility | | $1,653.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,810.78 / $8,958.04 / $17,327.75
| Facility | | $6,810.78 | $8,958.04 | $17,327.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.40 / $1,387.40 / $1,387.40
| Facility | | $1,387.40 | $1,387.40 | $1,387.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.75 / $1,285.05 / $4,509.66
| Facility | | $715.75 | $1,285.05 | $4,509.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.37 / $497.27 / $497.27
| Facility | AS | $202.37 | $497.27 | $497.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $1,618.63 / $2,293.77
| Facility | | $953.00 | $1,618.63 | $2,293.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.47 / $5,356.00 / $7,934.00
| Facility | | $1,522.47 | $5,356.00 | $7,934.00 |