- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,981.07 / $7,762.47
| Facility | | $1,288.25 | $3,981.07 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,489.63 / $21,877.62
| Facility | | $8,709.64 | $13,489.63 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,230.27 / $7,943.28
| Facility | | $288.40 | $1,230.27 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $79.43 / $1,905.46 / $1,905.46
| Facility | AS | $79.43 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,570.88 / $8,511.38
| Facility | | $1,230.27 | $4,570.88 | $8,511.38 |