- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,216.25 / $8,023.32 / $21,899.37
| Facility | | $2,216.25 | $8,023.32 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,198.33 / $7,045.08 / $13,225.41
| Facility | | $5,198.33 | $7,045.08 | $13,225.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.55 / $1,232.14 / $9,696.00
| Facility | | $683.55 | $1,232.14 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,279.44 / $1,279.44 / $1,279.44
| Facility | AS | $1,279.44 | $1,279.44 | $1,279.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.00 / $1,714.64 / $2,284.73
| Facility | | $1,327.00 | $1,714.64 | $2,284.73 |
- 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 |