- 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
- $4,634.43 / $4,634.43 / $4,634.43
| Facility | | $4,634.43 | $4,634.43 | $4,634.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.90 / $1,638.02 / $8,632.00
| Facility | | $912.90 | $1,638.02 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.53 / $1,661.06 / $1,661.06
| Facility | AS | $251.53 | $1,661.06 | $1,661.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.09 / $2,319.44 / $5,870.28
| Facility | | $1,207.09 | $2,319.44 | $5,870.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,210.00 / $7,221.00 / $8,632.00
| Facility | | $6,210.00 | $7,221.00 | $8,632.00 |