- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,623.41 / $9,549.93
| Facility | | $2,290.87 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $10,000.00
| Facility | | $2,238.72 | $4,897.79 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $12,882.50 / $17,782.79
| Facility | | $10,715.19 | $12,882.50 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,715.35 / $11,220.18
| Facility | | $1,318.26 | $3,715.35 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.13 / $1,318.26 / $1,318.26
| Facility | AS | $331.13 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,890.45 / $7,943.28
| Facility | | $2,454.71 | $3,890.45 | $7,943.28 |