- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,890.45 / $7,762.47
| Facility | | $2,089.30 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $7,943.28
| Facility | | $1,659.59 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,000.00 / $8,511.38
| Facility | | $691.83 | $1,000.00 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $186.21 / $338.84
| Facility | AS | $186.21 | $186.21 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,244.36 / $10,964.78
| Facility | | $5,248.07 | $7,244.36 | $10,964.78 |