- 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
- $4,180.02 / $5,453.87 / $10,634.64
| Facility | | $4,180.02 | $5,453.87 | $10,634.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.47 / $1,821.47 / $1,821.47
| Facility | | $1,821.47 | $1,821.47 | $1,821.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.75 / $1,925.15 / $7,441.00
| Facility | | $841.75 | $1,925.15 | $7,441.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $652.85 / $652.85 / $652.85
| Facility | AS | $652.85 | $652.85 | $652.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.58 / $2,003.61 / $2,531.00
| Facility | | $1,077.58 | $2,003.61 | $2,531.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |