- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,128.61 / $12,882.50
| Facility | | $1,047.13 | $5,128.61 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $9,332.54 / $14,791.08
| Facility | | $5,888.44 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,862.09 / $10,232.93
| Facility | | $776.25 | $1,862.09 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $1,905.46 / $1,905.46
| Facility | AS | $190.55 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |