- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.20 / $3,802.72 / $8,782.79
| Facility | | $931.20 | $3,802.72 | $8,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,602.87 / $8,785.64 / $13,706.31
| Facility | | $5,602.87 | $8,785.64 | $13,706.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.54 / $966.08 / $6,840.79
| Facility | | $693.54 | $966.08 | $6,840.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $170.46 / $849.00 / $849.00
| Facility | AS | $170.46 | $849.00 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,424.00 / $7,077.94
| Facility | | $1,157.00 | $4,424.00 | $7,077.94 |