- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.13 / $4,071.00 / $8,074.09
| Facility | | $1,007.13 | $4,071.00 | $8,074.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,387.39 / $10,015.81 / $15,625.45
| Facility | | $6,387.39 | $10,015.81 | $15,625.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,659.86 / $5,659.86 / $5,659.86
| Facility | | $5,659.86 | $5,659.86 | $5,659.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.86 / $1,145.19 / $8,986.49
| Facility | | $814.86 | $1,145.19 | $8,986.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.19 / $1,887.52 / $1,887.52
| Facility | AS | $199.19 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.00 / $6,334.00 / $10,811.00
| Facility | | $1,862.00 | $6,334.00 | $10,811.00 |