- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,913.00 / $4,518.60 / $13,841.56
| Facility | | $1,913.00 | $4,518.60 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,810.78 / $10,018.03 / $17,327.75
| Facility | | $6,810.78 | $10,018.03 | $17,327.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,646.10 / $6,646.10 / $6,646.10
| Facility | | $6,646.10 | $6,646.10 | $6,646.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $697.40 / $1,220.45 / $7,221.00
| Facility | | $697.40 | $1,220.45 | $7,221.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $195.85 / $2,382.07 / $2,382.07
| Facility | AS | $195.85 | $2,382.07 | $2,382.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.27 / $1,815.29 / $7,975.31
| Facility | | $1,263.27 | $1,815.29 | $7,975.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |