- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.31 / $5,463.36 / $13,841.56
| Facility | | $2,318.31 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,099.31 / $6,910.87 / $12,973.48
| Facility | | $5,099.31 | $6,910.87 | $12,973.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.27 / $1,187.34 / $9,696.00
| Facility | | $660.27 | $1,187.34 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,537.78 / $1,537.78 / $1,537.78
| Facility | AS | $1,537.78 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.55 / $1,566.71 / $5,275.65
| Facility | | $1,171.55 | $1,566.71 | $5,275.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |