- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,606.93 / $11,748.98
| Facility | | $2,344.23 | $6,606.93 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $8,128.31
| Facility | | $1,659.59 | $5,370.32 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $9,120.11
| Facility | | $9,120.11 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,445.44 / $10,000.00
| Facility | | $933.25 | $1,445.44 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.19 / $2,630.27 / $2,630.27
| Facility | AS | $251.19 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,413.10 / $10,964.78
| Facility | | $5,495.41 | $7,413.10 | $10,964.78 |